Individual provider Active NPI

Jessee Crane, M.D.

  • Family Medicine Physician
  • Ellisville, MO
National Provider Identifier
1417974080
Registry record updated Feb 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R6H65 Issued in MO
Practice address
233 Clarkson Rd
Ellisville, MO 63011-2219
Phone
(636) 256-8644
NPI assigned
Jul 17, 2006
Last updated
Feb 9, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R6H65 MO Primary

Addresses

Primary practice location

233 Clarkson Rd
Ellisville, MO 63011-2219

Mailing address

18747 Wild Horse Farm CT
Wildwood, MO 63038-1186
Phone (636) 458-1758

Other identifiers 1

IdentifierTypeStateIssuer
P00349313OtherMORR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20061019000430 MO Practitioner - Family Practice 3779589494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Physicians of St Lukes LLCGroup PAC ID 3779714142, 63 clinicians

Practice addresses (Care Compare)

233 Clarkson Rd
Ellisville, MO 63011-2219
Phone (636) 256-8644

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.71 of 100Reported as apm
Quality
82.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R6H65MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of St. Luke's, LLC Family Medicine CurrentSince Mar 1, 2014 Accepting new patients

Locations

12304 Manchester Rd
Des Peres, MO 63131
Phone (314) 965-6871

233 Clarkson Rd
Ellisville, MO 63011
Phone (636) 256-8644

508 Old Smizer Mill Rd
Fenton, MO 63026
Phone (636) 343-5223

11550 Olive Blvd
Saint Louis, MO 63141
Phone (314) 542-7690

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234137600000",
    "number": "1417974080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18747 WILD HORSE FARM CT",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630381186",
            "telephone_number": "636-458-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 CLARKSON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112219",
            "telephone_number": "636-256-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRANE",
        "first_name": "JESSEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2009-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R6H65",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00349313",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

Verify at the official NPI Registry.