Randall B Crockett, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7107 Issued in AZ

Practice address

1121 S Main St
Snowflake, AZ 85937-5645

Phone

(928) 536-5858

Fax

(928) 536-2196

NPI assigned

Dec 15, 2006

Last updated

Apr 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Healthcare Medical AssociatesGroup PAC ID 8729205737, 74 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Summit Healthcare Regional Medical Center Hospital, Show Low, AZ, CCN 030062

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: randallcrockett@shrmcshma.allscriptsdirect.net

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.

• Summit Healthcare Medical Associates

  • Family Medicine Physician
  • Show Low, AZ
  • NPI 1467878108
  Medicare reassignment Care Compare group
• Summit Healthcare Association

  dba Summit Healthcare Regional Medical Center

  • Rural Acute Care Hospital
  • Show Low, AZ
  • NPI 1144209271

  Physician Assistant

  NPD
• Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Eagar, AZ
  • NPI 1063166999
  NPD
• Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Snowflake, AZ
  • NPI 1134873060
  NPD
• Summit Healthcare Association

  dba Summit Healthcare Oncology Center

  • Oncology Clinic/Center
  • Show Low, AZ
  • NPI 1083736128
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Summit Healthcare Association

  dba Summit Healthcare Oncology Center

  • Oncology Clinic/Center
  • Show Low, AZ
  • NPI 1083736128

  Hospital

  Care Compare affiliation
• Summit Healthcare Association

  dba Summit Healthcare Regional Medical Center

  • Rural Acute Care Hospital
  • Show Low, AZ
  • NPI 1144209271
  Care Compare affiliation
• Summit Healthcare Medical Associates

  dba Family Medicine at Bison Ranch

  • Rural Health Clinic/Center
  • Overgaard, AZ
  • NPI 1770700767

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1295897957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 S MAIN ST",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859375645",
            "telephone_number": "928-536-5858",
            "fax_number": "928-536-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 S MAIN ST",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859375645",
            "telephone_number": "928-536-5858",
            "fax_number": "928-536-2196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "RANDALL",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433696",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clara Louise Crookston, LCSW
• Alan N Dewitt, M.D.
• Don Shumway D P M PC
• Eagledancer Youth and Family Services, Inc.

• Physician Assistant in Snowflake, AZ
• Providers in Snowflake, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.