Active NPI
Dallas Payne Crickenberger, MD
- Orthopaedic Surgery Physician
- Roanoke, VA
National Provider Identifier
1417921362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 0101-017904
- Practice address
- 3 Riverside Cir
Roanoke, VA 24016-4955 - Phone
- (540) 725-1226
- Fax
- (540) 857-5306
- NPI assigned
- Feb 16, 2006
- Last updated
- Mar 10, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 0101-017904 | VA | Primary |
Addresses
Primary practice location
3 Riverside Cir
Roanoke, VA 24016-4955
Mailing address
3 Riverside Cir
Roanoke, VA 24016-4955
Phone (540) 725-1226
Other identifiers 20
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417921362 | Other | VA | HEALTHKEEPERS PLUS |
| 1417921362 | Other | VA | UNITED HEALTHCARE |
| 1417921362 | Other | VA | UMWA |
| 1417921362 | Other | VA | GATEWAY |
| 540506332004 | Other | VA | TRICARE/CHAMPUS |
| 1417921362 | Other | VA | AETNA |
| 371194700 | Other | VA | BLACK LUNG |
| 1417921362 | Other | VA | ANTHEM |
| 1417921362 | Other | VA | SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY |
| 0097064000 | Other | VA | MEDICAID OF WEST VIRGINIA |
| 1417921362 | Other | VA | VA PREMIER |
| 1417921362 | Other | VA | HEALTHKEEPERS |
| 1417921362 | Other | VA | CIGNA |
| 1417921362 | Other | VA | VIRGINIA HEALTH NETWORK |
| 1417921362 | Other | VA | HUMANA MEDICARE |
| 1417921362 | Medicaid | VA | |
| P200030655 | Other | VA | RAILROAD MEDICARE |
| 1417921362 | Other | VA | MAJESTACARE |
| 1417921362 | Other | VA | INTOTAL |
| 1417921362 | Other | VA | OPTIMA HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101-017904 | VA | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394409600000",
"number": "1417921362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 RIVERSIDE CIR",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240164955",
"telephone_number": "540-725-1226",
"fax_number": "540-857-5306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 RIVERSIDE CIR",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240164955",
"telephone_number": "540-725-1226",
"fax_number": "540-857-5306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRICKENBERGER",
"first_name": "DALLAS",
"middle_name": "PAYNE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-16",
"last_updated": "2014-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "VA",
"license": "0101-017904",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHKEEPERS PLUS",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE/CHAMPUS",
"identifier": "540506332004",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLACK LUNG",
"identifier": "371194700",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID OF WEST VIRGINIA",
"identifier": "0097064000",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA PREMIER",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHKEEPERS",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIRGINIA HEALTH NETWORK",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA MEDICARE",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P200030655",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAJESTACARE",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INTOTAL",
"identifier": "1417921362",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA HEALTH PLAN",
"identifier": "1417921362",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.