Active NPI
Jason Malcolm Crandell, M.D.
- Specialist
- Clemmons, NC
National Provider Identifier
1255349098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 23500
- Practice address
- 2511 Neudorf Rd Ste D
Clemmons, NC 27012-8922 - Phone
- (336) 778-0506
- Fax
- (336) 778-0570
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 23500 | NC | Primary |
Addresses
Primary practice location
2511 Neudorf Rd Ste D
Clemmons, NC 27012-8922
Mailing address
PO Box 1741
Clemmons, NC 27012-1741
Phone (336) 778-0506
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 73006 | Other | NC | MEDCOST |
| 8925220 | Medicaid | NC | |
| MR109 | Other | NC | BLUE CROSS EMPIRE |
| 05667001 | Other | NC | MAGELLAN |
| 1504998 | Other | NC | UNITED HEALTH CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1255349098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1741",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270121741",
"telephone_number": "336-778-0506",
"fax_number": "336-778-0570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2511 NEUDORF RD STE D",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270128922",
"telephone_number": "336-778-0506",
"fax_number": "336-778-0570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRANDELL",
"first_name": "JASON",
"middle_name": "MALCOLM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "23500",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "73006",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8925220",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS EMPIRE",
"identifier": "MR109",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "05667001",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "1504998",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clemmons, NC
- Glen Edward Combs, P.A.
- Complete Rehab
- Cornerstone Health Care PA (Mothershed Mothershed Arne Cates & Cane)
- Dylan William Cortese, BS, MSPAS, PA-C
- Marina Coutros, RBT
- Charles Edward Craven Jr., M.D.
- Alexander Rowan Craver, D.D.S.
- Scott Crawford
- Hannah Leah Creel, MA, MDIV
- Austin Chapman-Lovette Cromer, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.