Individual provider Active NPI

Andrea Crystal

  • Nurse Practitioner
  • Provo, UT
National Provider Identifier
1316726987
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
10378599-4405 Issued in UT
Practice address
395 W Cougar Blvd
Provo, UT 84604-3311
Phone
(801) 357-7420
NPI assigned
Sep 25, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 10378599-4405 UT Primary

Addresses

Primary practice location

395 W Cougar Blvd
Provo, UT 84604-3311

Mailing address

142 N 450 W
American Fork, UT 84003-1499
Phone (801) 859-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20240220001618 UT Practitioner - Nurse Practitioner 1951745785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

395 W Bulldog Blvd
Provo, UT 84604-3311
Phone (801) 357-7081

Hospital & facility affiliations

  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
  • American Fork Hospital Hospital, American Fork, UT, CCN 460023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Jan 1, 2024 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

395 W Cougar Blvd
Ste 801
Provo, UT 84604
Phone (801) 229-1054

395 W Cougar Blvd
Provo, UT 84604
Phone (801) 357-4141

395 W Cougar Blvd
Ste 502
Provo, UT 84604
Phone (801) 229-1054

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1316726987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 N 450 W",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840031499",
            "telephone_number": "801-859-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043311",
            "telephone_number": "801-357-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRYSTAL",
        "first_name": "ANDREA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "10378599-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.