NPIMap

Organization Active NPI

Psimed PA

  • Psychiatry Physician
  • Clemmons, NC
National Provider Identifier
1366613663
Registry record updated Mar 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
23500 Issued in NC
Legal business name
PSIMED PA
Practice address
2511-D Neudorf Rd
Clemmons, NC 27012
Phone
(336) 778-0506
Fax
(336) 778-0570
NPI assigned
Mar 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2008

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

Authorized official

Name
Dr. Jason Malcolm Crandell, MD
Title
President
Phone
(336) 918-4882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 23500 NC Primary

Addresses

Primary practice location

2511-D Neudorf Rd
Clemmons, NC 27012

Mailing address

PO Box 1741
Clemmons, NC 27012
Phone (336) 778-0506

National Provider Directory

National Provider Directory

Locations

2511 Neudorf Rd
Ste D
Clemmons, NC 27012
Phone (336) 778-0506

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205452800000",
    "number": "1366613663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1741",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "27012",
            "telephone_number": "336-778-0506",
            "fax_number": "336-778-0570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511-D NEUDORF RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "27012",
            "telephone_number": "336-778-0506",
            "fax_number": "336-778-0570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSIMED PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2008-03-14",
        "status": "A",
        "authorized_official_last_name": "CRANDELL",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "MALCOLM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-918-4882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "23500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.