Active NPI
Crystal Laniece Clay, PA-C
- Physician Assistant
- Gainesville, FL
National Provider Identifier
1346568896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9104891
- Practice address
- 4410 Newberry Rd Ste A3
Gainesville, FL 32607-2290 - Phone
- (352) 262-6257
- NPI assigned
- May 7, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9104891 | FL | Primary |
Addresses
Primary practice location
4410 Newberry Rd Ste A3
Gainesville, FL 32607-2290
Mailing address
4410 Newberry Rd Ste A3
Gainesville, FL 32607-2290
Phone (352) 262-6257
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2015 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9104891 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581984000000",
"number": "1346568896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4410 NEWBERRY RD STE A3",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326072290",
"telephone_number": "352-262-6257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4410 NEWBERRY RD STE A3",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326072290",
"telephone_number": "352-262-6257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAY",
"first_name": "CRYSTAL",
"middle_name": "LANIECE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-07",
"last_updated": "2020-02-18",
"certification_date": "2020-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9104891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.