Individual provider Active NPI

Jason Blair Crofts, D.O.

  • Emergency Medicine Physician
  • Erie, PA
National Provider Identifier
1417218769
Registry record updated Jun 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OT014460 Issued in PA
Practice address
2314 Sassafras St
2ND Floor
Erie, PA 16502-2722
Phone
(814) 452-5105
Fax
(814) 452-5097
NPI assigned
Jun 4, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OT014460 PA Primary

Addresses

Primary practice location

2314 Sassafras St
2ND Floor
Erie, PA 16502-2722

Mailing address

2314 Sassafras St
2ND Floor
Erie, PA 16502-2722
Phone (814) 452-5105

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20191227001002 ID Practitioner - Emergency Medicine 8921314436 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone (208) 529-6111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT014460PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Integrated Care, LLC Emergency Medicine CurrentSince Jan 1, 2022 Accepting new patients
Intermountain Emergency Physicians Emergency Medicine CurrentSince Oct 25, 2019 Accepting new patients
St Vincent Medical Education and Research Institute Inc Family Medicine PastSince Jun 29, 2025 Accepting new patients

Locations

2327 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-1000

3100 Channing Way
Idaho Falls, ID 83404
Phone (208) 227-2100

Organizations & group practices 3

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 2

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": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338768000000",
    "number": "1417218769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2314 SASSAFRAS ST",
            "address_2": "2ND FLOOR",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022722",
            "telephone_number": "814-452-5105",
            "fax_number": "814-452-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2314 SASSAFRAS ST",
            "address_2": "2ND FLOOR",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022722",
            "telephone_number": "814-452-5105",
            "fax_number": "814-452-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROFTS",
        "first_name": "JASON",
        "middle_name": "BLAIR",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OT014460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.