Crystal Vaughn Manse, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036139867 Issued in IL

Practice address

3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284

Phone

(618) 233-5480

Fax

(618) 222-4792

NPI assigned

May 18, 2012

Last updated

Sep 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

96.63

Improvement activities

40

Cost

81.81

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cep America - Illinois SNF, LLP

  • Internal Medicine Physician
  • Belleville, IL
  • NPI 1073069415
  Medicare reassignment NPD
• Cep America-Illinois Hospitalists, LLP

  • Internal Medicine Physician
  • Belleville, IL
  • NPI 1841613403
  Medicare reassignment NPD
• Southern Illinois Healthcare Foundation Inc

  dba Centreville Health Center

  • Federally Qualified Health Center (FQHC)
  • Centreville, IL
  • NPI 1609813500

  Internal Medicine

  Medicare reassignment NPD
• Galen Inpatient Physicians, PC

  • Hospitalist Physician
  • Manteca, CA
  • NPI 1689320459
  Medicare reassignment NPD
• Cep America - Illinois SNF LLP

  • Internal Medicine Physician
  • Edwardsville, IL
  • NPI 1043170434
  NPD
• Cep America - Illinois SNF, LLP

  • Infectious Disease Physician
  • Belleville, IL
  • NPI 1720590045
  NPD
• Cep America-Illinois Hospitalists

  • Hospitalist Physician
  • Bloomington, IL
  • NPI 1669276523
  NPD
• Cep America-Illinois Hospitalists, LLP

  • Internal Medicine Physician
  • Shiloh, IL
  • NPI 1619335106
  NPD
• Southern Illinois Healthcare Foundation Inc

  dba SIHF Healthcare

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IL
  • NPI 1821813247
  NPD
• Southern Illinois Healthcare Foundation, Inc.

  dba Fairmont City Health Center

  • Federally Qualified Health Center (FQHC)
  • East Saint Louis, IL
  • NPI 1770648917
  NPD
• Galen Inpatient Physicians PC

  • Hospitalist Physician
  • Los Angeles, CA
  • NPI 1205787686
  NPD
• Galen Inpatient Physicians PC

  • Internal Medicine Physician
  • Victorville, CA
  • NPI 1225672967
  NPD

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

{
    "created_epoch": "1337299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1366702870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SAINT ELIZABETH BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691281",
            "telephone_number": "618-234-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SAINT ELIZABETH BLVD STE 4000",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691284",
            "telephone_number": "618-233-5480",
            "fax_number": "618-222-4792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "375th Medical Group",
            "address_2": "310W LOSEY ST",
            "address_purpose": "LOCATION",
            "city": "Scott AFB",
            "state": "IL",
            "postal_code": "62225",
            "country_code": "US",
            "telephone_number": "618-256-7799",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 Bergquist Dr",
            "address_2": "Wilford Hall Ambulatory Surgical Center",
            "address_purpose": "LOCATION",
            "city": "Lackland A F B",
            "state": "TX",
            "postal_code": "782369907",
            "country_code": "US",
            "telephone_number": "210-292-7805",
            "fax_number": "210-292-7868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSE",
        "first_name": "CRYSTAL",
        "middle_name": "VAUGHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-18",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101255760",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036139867",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036139867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriele E Malone, RBT
• Angela Nicole Mangum
• Angela Mann, RNC-OB, IBCLC
• Sarah R Mannix
• Jami Lee Mannle, FNP-BC
• Johnathan Jay Marchbanks, MSW
• Alexandria Marion, RBT
• Whitney Marlow, M.D.
• Scott Benjamin Marrus, MD
• Jacob C. Marshall Jr., M.D.

• Internal Medicine Physician in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.