Jack Joseph Cristiano Jr., PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

9116364 Issued in FL

Practice address

1625 SE 3Rd Ave Ste 300
Fort Lauderdale, FL 33316-2521

Phone

(954) 355-4665

Fax

(954) 355-4881

NPI assigned

Jan 5, 2021

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

Medicare fee-for-service enrollment

Enrolled in FL, WY2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cheyenne Regional Physicians Group LLCGroup PAC ID 2961403639, 101 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cheyenne Regional Medical Center Hospital, Cheyenne, WY, CCN 530014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cheyenne Regional Physicians Group, LLC

  • Medical Oncology Physician
  • Cheyenne, WY
  • NPI 1659458008
  Medicare reassignment Care Compare group
• North Broward Hospital District

  • Neurological Surgery Physician
  • Fort Lauderdale, FL
  • NPI 1801581129
  Medicare reassignment
• North Broward Hospital District

  • Gynecologic Oncology Physician
  • Fort Lauderdale, FL
  • NPI 1649808916
  NPD
• North Broward Hospital District

  • Community/Retail Pharmacy
  • Pompano Beach, FL
  • NPI 1699709766
  NPD
• Cheyenne Children'S Clinic, PC

  • Pediatrics Physician
  • Cheyenne, WY
  • NPI 1073537601
  NPD (past)

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

• Memorial Hospital of Laramie County

  • General Acute Care Hospital
  • Cheyenne, WY
  • NPI 1285621839
  Care Compare affiliation

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1356939409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NW 49TH ST STE 125",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333093750",
            "telephone_number": "954-355-4665",
            "fax_number": "954-355-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SE 3RD AVE STE 300",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162521",
            "telephone_number": "954-355-4665",
            "fax_number": "954-355-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISTIANO",
        "first_name": "JACK",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-05",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "9116364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ieesha Crawford, LCSW
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• Danielle Crespi, LMHC
• Viviana Crespo, MD
• Elissa Crist, LMFT
• Tanese Croasdale
• Nikolas Crocker
• Crockett Foundation Inc
• Stephanie A Crofutt, LCSW
• Tabitha Crosno

• Surgical Physician Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.