Crystal Canyon ENT & Facial Plastic Surgery PC

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

MD3000 Issued in AZ

Legal business name

CRYSTAL CANYON ENT & FACIAL PLASTIC SURGERY PC

Practice address

1340 N Rim Dr
Flagstaff, AZ 86001-3111

Phone

(928) 774-1873

Fax

(928) 774-5525

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Pamela A Taylor

Title

Office Manager

Phone

(928) 774-1873

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Ccent & FPS

  • Allergy & Immunology Physician
  • Lakeside, AR
  • NPI 1467629469

  O20040210000400

  Same enrollment

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tamarah Fratianni, D.O

  • Facial Plastic Surgery Physician
  • Flagstaff, AZ
  • NPI 1689673972
  Medicare reassignment NPD

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1285780767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 N RIM DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013111",
            "telephone_number": "928-774-1873",
            "fax_number": "928-774-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 N RIM DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013111",
            "telephone_number": "928-774-1873",
            "fax_number": "928-774-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CANYON ENT & FACIAL PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-774-1873",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "AZ",
            "license": "MD3000",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "AZ",
            "license": "MD3000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "316762",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1000074",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSAZ",
            "identifier": "AZ0228870",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradford Croft, D.O.
• Todd Steven Crone, PT
• Keith A. Cross, PH.D., LMFT
• Christine Crowder, MD
• Jennifer A Crownhart, CRNA
• Ashleigh Cseh
• Tyler Cuilla, LIAC
• Kristan Elizabeth Culbertson, M.S., CCC-SLP
• Lonna Eleanor Culbertson, R.N.
• Cristina Culhane, LCSW

• Otolaryngology/Facial Plastic Surgery Physician in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.