Individual provider Active NPI

Crystle Kay Laugavitz, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Granite City, IL
National Provider Identifier
1386220259
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209023034 Issued in IL
Practice address
2100 Madison Ave
Granite City, IL 62040-4713
Phone
(618) 798-3000
NPI assigned
Mar 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209023034 IL Primary

Addresses

Primary practice location

2100 Madison Ave
Granite City, IL 62040-4713

Mailing address

2945 Century Dr
Granite City, IL 62040-2141
Phone (618) 304-5388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210604002678 IL Practitioner - Nurse Practitioner 5294134672 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Saint Louis University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Clinical Research Associates PCGroup PAC ID 5597662080, 21 clinicians

Practice addresses (Care Compare)

2044 Madison Ave
Granite City, IL 62040-4641
Phone (314) 549-8494

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209023034ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Research Associates, PC CurrentSince Apr 1, 2025 Accepting new patients
Ahs Il Medical Group LLC CurrentSince Oct 8, 2023 Accepting new patients

Locations

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

6301 Humbert Rd
Godfrey, IL 62035
Phone (618) 446-0367

2100 Madison Ave
Ste 206
Granite City, IL 62040
Phone (618) 798-3000

2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000

2044 Madison Ave
Ste G1
Granite City, IL 62040
Phone (618) 798-3350

2044 Madison Ave
Ste G2
Granite City, IL 62040
Phone (314) 549-8494

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

1400 Lemay Ferry Rd
Saint Louis, MO 63125
Phone (314) 338-7955

Interoperability endpoints

  • Direct secure messaging: crystle.laugavitz.1@28328.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1386220259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 CENTURY DR",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620402141",
            "telephone_number": "618-304-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404713",
            "telephone_number": "618-798-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUGAVITZ",
        "first_name": "CRYSTLE",
        "middle_name": "KAY",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209023034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

Verify at the official NPI Registry.