Crystal City Pulmonary Critical Care & Sleep Medicine

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

2004030200 Issued in MO

Legal business name

CRYSTAL CITY PULMONARY CRITICAL CARE & SLEEP MEDICINE

Practice address

1390 US Highway 61 Ste 2300
Festus, MO 63028-4121

Phone

(636) 937-3121

Fax

(636) 937-4423

NPI assigned

Feb 1, 2007

Last updated

Oct 21, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sarah Ingram, CPC

Title

Office Manager

Phone

(636) 937-3121

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amanda E Avellone, MD

  • Pulmonary Disease Physician
  • Festus, MO
  • NPI 1154325082
  Medicare reassignment NPD
• Adetayo Richard Ademuyiwa, M.D.

  • Pulmonary Disease Physician
  • Saint Louis, MO
  • NPI 1407944911
  NPD
• Warren M Breite, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Festus, MO
  • NPI 1457355372

  Multi-Specialty

  NPD

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413849600000",
    "number": "1326186602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4468 SOUTHVIEW WAY DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631296718",
            "telephone_number": "636-937-3121",
            "fax_number": "636-937-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 US HIGHWAY 61 STE 2300",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284121",
            "telephone_number": "636-937-3121",
            "fax_number": "636-937-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CITY PULMONARY CRITICAL CARE & SLEEP MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "636-937-3121",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "2004030200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500828603",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207306903",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew James Crisp, M.D., PH.D.
• Critical Care Pulmonary & Sleep Medicine Assoc LLC
• Tamra Lynn Crouch, FNP
• Crystal Cities Surgery Center (Twin Cities Surgery Center)
• Crystal City Foot & Ankle Care PC
• Crystal Oaks Long Term Care (Crystal Oaks)
• Crystal Oaks Nursing and Rehab LLC
• Crystal Oaks Nursing and Rehab LLC (Crystal Oaks)
• Andrea L Cuneio
• Rebecca Jean Dalton, MSN, PMHNP-BC

• Pulmonary Disease Physician in Festus, MO
• Providers in Festus, MO by specialty
• Pulmonary Disease Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.