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Individual provider Active NPI

Crystal Nicole Bohannon, APRN-NP

  • Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1457738387
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3009368 Issued in KY
Practice address
8111 Bardstown Rd
Louisville, KY 40291-3441
Phone
(502) 231-7680
Fax
(502) 231-8149
NPI assigned
Apr 29, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3009368 KY Primary

Addresses

Primary practice location

8111 Bardstown Rd
Louisville, KY 40291-3441

Mailing address

100 E Liberty St
Suite 800
Louisville, KY 40202-1434
Phone (502) 231-7680

Other identifiers 1

IdentifierTypeStateIssuer
7100382320 (KOHMG)MedicaidKY

Other names 1

  • Crystal Nicole Bristoe Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151110003027 KY Practitioner - Nurse Practitioner 6002126661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Louisville Physicians Inc 1,438 clinicians

Practice addresses (Care Compare)

215 Central Ave
Suite 100
Louisville, KY 40208-1450
Phone (502) 588-8720

Hospital & facility affiliations

  • Amedisys SP-Ky, LLC Dba Adoration Home Health Home health agency, Louisville, KY, CCN 187143
  • UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Hospital, Louisville, KY, CCN 180040
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130
  • Baptist Health Lagrange Hospital, La Grange, KY, CCN 180138

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Oct 11, 2019 Accepting new patients
University of Louisville Physicians, Inc. Nurse Practitioner Current Accepting new patients
University of Louisville Physicians CurrentSince Oct 11, 2019 Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

5100 Outer Loop
Louisville, KY 40219
Phone (502) 968-6226

215 Central Ave
Ste 100
Louisville, KY 40208
Phone (502) 588-8720

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

8111 Bardstown Rd
Louisville, KY 40291
Phone (502) 231-7680

Interoperability endpoints

  • Direct secure messaging: cbohannon13557@uoflhealth-dm.org

Organizations & group practices 6

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 25

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1457738387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LIBERTY ST",
            "address_2": "SUITE 800",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021434",
            "telephone_number": "502-231-7680",
            "fax_number": "502-231-8149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8111 BARDSTOWN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402913441",
            "telephone_number": "502-231-7680",
            "fax_number": "502-231-8149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOHANNON",
        "first_name": "CRYSTAL",
        "middle_name": "NICOLE",
        "credential": "APRN-NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-29",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3009368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100382320 (KOHMG)",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "BRISTOE",
            "middle_name": "NICOLE",
            "credential": "APRN-NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.