Christiian Storm Credle, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS019097 Issued in PA

Practice address

907 Chester Pike
Sharon Hill, PA 19079-1411

Phone

(610) 583-1177

Fax

(610) 583-1177

NPI assigned

Sep 9, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mazzoni CenterGroup PAC ID 8527043736, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: christiian.credle.1@2819.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 and National Provider Directory roles.

• Mazzoni Center

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1477631307
  Medicare reassignment Care Compare group NPD
• AIDS Care Group

  • Clinic/Center
  • Chester, PA
  • NPI 1477592400
  Medicare reassignment NPD
• AIDS Care Group

  • Pharmacy
  • Eddystone, PA
  • NPI 1871913327
  NPD
• Jefferson University Physicians

  • Gastroenterology Physician
  • Phila, PA
  • NPI 1205898723
  NPD (past)

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1316552102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 S 18TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452103",
            "telephone_number": "732-395-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 CHESTER PIKE",
            "city": "SHARON HILL",
            "state": "PA",
            "postal_code": "190791411",
            "telephone_number": "610-583-1177",
            "fax_number": "610-583-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREDLE",
        "first_name": "CHRISTIIAN",
        "middle_name": "STORM",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS019097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISENCE NUMBER",
            "identifier": "PS019097",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "christiiancredle@aidscaregroup.org",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "address_1": "907 Chester Pike",
            "city": "Sharon Hill",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190791411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychologist in Sharon Hill, PA
• Providers in Sharon Hill, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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.