Michelle Christine Crocker, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8443 Issued in OR

Practice address

11786 SW Barnes Rd Ste 320
Portland, OR 97225-5930

Phone

(503) 641-3550

NPI assigned

May 22, 2008

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 OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Michelle C. Crocker, DMD, PC

  • Dentist
  • Portland, OR
  • NPI 1235456153
  NPD (past) Authorized official

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412553600000",
    "number": "1295993541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11786 SW BARNES RD STE 320",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255930",
            "telephone_number": "503-641-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11786 SW BARNES RD STE 320",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255930",
            "telephone_number": "503-641-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKER",
        "first_name": "MICHELLE",
        "middle_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-22",
        "last_updated": "2014-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Crivellone, BS
• Todd Shane Crocenzi, M.D.
• Dakota Wolf Crocker, MD
• Emily Crocker, LCSW
• Julie Crocker, MD
• Sydnee Lee Crocker
• Alexandra Crockett, PSYD
• Cody Crockett
• Seth D Crockett, MD, MPH
• Amy Jennifer Malia Crockford

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; 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.