Crystal C Tidwell, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS14104 Issued in FL

Practice address

23 Mack Bayou Loop
Ste 200
Santa Rosa Beach, FL 32459-2606

Phone

(850) 278-3920

Fax

(850) 278-3919

NPI assigned

Jul 10, 2013

Last updated

Sep 23, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: crystal.tidwell.3@9582.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sacred Heart Health System, Inc.

  dba Ascension Medical Group Sacred Heart

  • Ambulatory Family Planning Facility
  • Pensacola, FL
  • NPI 1962453308
  Medicare reassignment NPD
• Sacred Heart Health System Inc

  dba Ascension Rx 1411

  • Community/Retail Pharmacy
  • Pensacola, FL
  • NPI 1366260739
  NPD
• Sacred Heart Health System, Inc.

  dba Ascension Medical Group Sacred Heart

  • Family Medicine Physician
  • Pensacola, FL
  • NPI 1144271586
  NPD
• Sacred Heart Health System, Inc.

  dba Ascension Medical Group Sacred Heart

  • Primary Care Clinic/Center
  • Pensacola, FL
  • NPI 1043261498
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474588800000",
    "number": "1275974909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "address_2": "ATTN: SHMG/HPE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-278-3920",
            "fax_number": "850-278-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 MACK BAYOU LOOP",
            "address_2": "STE 200",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "324592606",
            "telephone_number": "850-278-3920",
            "fax_number": "850-278-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "CRYSTAL",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-10",
        "last_updated": "2016-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS14104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Galen Group (ExpressCare)
• The Hope Center- Counseling (HopeCounseling.Online)
• The Reach Institute of North West Florida
• Scott Patrick Thurston, DC
• Brett R Tidwell, DO
• Natalie Yazdani Tidwell, M.D.
• Tjal Enterprises Inc. (Santa Rosa Beach Counseling)
• TMJ & Sleep Center LLC
• Cynthia C Townsend, ARNP, FNP-BC
• Ashley Alaine Trahan, PT, DPT

• Pediatrics Physician in Santa Rosa Beach, FL
• Providers in Santa Rosa Beach, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.