Active NPI
Crystal Bazemore, BSN, RN
- Registered Nurse
- Glen Burnie, MD
National Provider Identifier
1265021661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R228867
- Practice address
- 1012 Wisdom CT
Glen Burnie, MD 21061-3966 - Phone
- (442) 618-7172
- NPI assigned
- Jan 11, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R228867 | MD | Primary |
Addresses
Primary practice location
1012 Wisdom CT
Glen Burnie, MD 21061-3966
Mailing address
1012 Wisdom CT
Glen Burnie, MD 21061-3966
Phone (442) 618-7172
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | crystal.bazemore@cityblock.com | Direct | Cityblock Medical Practice NC, P.C. |
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)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R228867 | MD | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610323200000",
"number": "1265021661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 WISDOM CT",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210613966",
"telephone_number": "442-618-7172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 WISDOM CT",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210613966",
"telephone_number": "442-618-7172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAZEMORE",
"first_name": "CRYSTAL",
"credential": "BSN, RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-11",
"last_updated": "2021-01-11",
"certification_date": "2021-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MD",
"license": "R228867",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "crystal.bazemore@cityblock.com",
"affiliation": "Y",
"affiliationName": "Cityblock Medical Practice NC, P.C.",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "615 S College St",
"city": "Charlotte",
"state": "NC",
"country_code": "US",
"postal_code": "282023354",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.