Active NPI
Gregory P Crucian, PHD
- Clinical Neuropsychologist
- Fort Riley, KS
National Provider Identifier
1457396293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PY5730
- Practice address
- 650 Huebner Rd
Fort Riley
Fort Riley, KS 66442 - Phone
- (850) 883-8150
- NPI assigned
- Jun 17, 2006
- Last updated
- Oct 27, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PY5730 | FL | Primary |
| Psychologist | 103T00000X | PY5730 | FL | |
| Clinical Psychologist | 103TC0700X | PY5730 | FL |
Addresses
Primary practice location
650 Huebner Rd
Fort Riley
Fort Riley, KS 66442
Mailing address
5313 Stone Crest Dr
Manhattan, KS 66503-8757
Phone (915) 255-9869
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 371230300 | Medicaid | FL |
Other names 1
- Gregory Paul Crucian
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY5730 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698364800000",
"number": "1457396293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5313 STONE CREST DR",
"city": "MANHATTAN",
"state": "KS",
"postal_code": "665038757",
"telephone_number": "915-255-9869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 HUEBNER RD",
"address_2": "FORT RILEY",
"city": "FORT RILEY",
"state": "KS",
"postal_code": "66442",
"telephone_number": "850-883-8150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUCIAN",
"first_name": "GREGORY",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-17",
"last_updated": "2023-10-27",
"certification_date": "2023-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "FL",
"license": "PY5730",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY5730",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY5730",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "371230300",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GREGORY",
"last_name": "CRUCIAN",
"middle_name": "PAUL",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fort Riley, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.