Active NPI
Philip Jay Crum, A.T.,C.
- Athletic Trainer
- Shelby Township, MI
National Provider Identifier
1306993894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- L488935
- Practice address
- 6500 25 Mile Rd
Shelby Township, MI 48316-1703 - Phone
- (586) 797-1300
- Fax
- (586) 797-1301
- NPI assigned
- Jan 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | L488935 | MI | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
6500 25 Mile Rd
Shelby Township, MI 48316-1703
Mailing address
71843 East Pond Creek
Bruce TWP, MI 48065
Phone (586) 331-7009
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L488935 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521158400000",
"number": "1306993894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71843 EAST POND CREEK",
"city": "BRUCE TWP",
"state": "MI",
"postal_code": "48065",
"telephone_number": "586-331-7009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 25 MILE RD",
"city": "SHELBY TOWNSHIP",
"state": "MI",
"postal_code": "483161703",
"telephone_number": "586-797-1300",
"fax_number": "586-797-1301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUM",
"first_name": "PHILIP",
"middle_name": "JAY",
"name_prefix": "Mr.",
"credential": "A.T.,C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2018-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "L488935",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelby Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.