NPIMap

Individual provider Active NPI

Dennis M Crockett, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Mission Viejo, CA
National Provider Identifier
1356362800
Registry record updated Nov 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
G42104 Issued in CA
Practice address
26726 Crown Valley Pkwy.
Suite 200 Head & Neck Associates of Orange County
Mission Viejo, CA 92691
Phone
(949) 364-4361
Fax
(949) 364-4495
NPI assigned
Jul 21, 2006
Last updated
Nov 26, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X G42104 CA Primary

Addresses

Primary practice location

26726 Crown Valley Pkwy.
Suite 200 Head & Neck Associates of Orange County
Mission Viejo, CA 92691

Mailing address

26726 Crown Valley Pkwy.
Suite 200 Head & Neck Associates of Orange County
Mission Viejo, CA 92691
Phone (949) 364-4361

Other identifiers 2

IdentifierTypeStateIssuer
W8109OtherGEL PTAN
00G421040MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080121000294 CA Practitioner - Otolaryngology 4486735016 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Head and Neck Associates of Orange County an IncorprateGroup PAC ID 0547211518, 16 clinicians

Practice addresses (Care Compare)

26726 Crown Valley Pkwy
Suite 200
Mission Viejo, CA 92691-8003
Phone (949) 364-4361

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
50 of 100Reported as individual
Quality
0
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G42104CAMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Head and Neck Associates of Orange County an Incorprate CurrentSince Feb 1, 2008 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
Los Alamitos Medical Center, Inc. Past Accepting new patients
Children's Hospital at Mission Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients

Locations

18 Endeavor
Ste 208
Irvine, CA 92618
Phone (949) 276-4008

26726 Crown Valley Pkwy
Ste 200
Mission Viejo, CA 92691
Phone (949) 264-4361

675 Camino de los Mares
Ste 420
San Clemente, CA 92673
Phone (949) 276-4008

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: dennism.crockett.p19@direct.monarchhealthcare.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227657600000",
    "number": "1356362800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26726 CROWN VALLEY PKWY.",
            "address_2": "SUITE 200 HEAD & NECK ASSOCIATES OF ORANGE COUNTY",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "92691",
            "telephone_number": "949-364-4361",
            "fax_number": "949-364-4495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26726 CROWN VALLEY PKWY.",
            "address_2": "SUITE 200 HEAD & NECK ASSOCIATES OF ORANGE COUNTY",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "92691",
            "telephone_number": "949-364-4361",
            "fax_number": "949-364-4495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "DENNIS",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2008-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "CA",
            "license": "G42104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEL PTAN",
            "identifier": "W8109",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G421040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.