NPIMap

Individual provider Active NPI

Matthew Crilley, D.C.

  • Chiropractor
  • Raleigh, NC
National Provider Identifier
1477530061
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2846 Issued in NC
Practice address
12740 Spruce Tree Way
Raleigh, NC 27614-8295
Phone
(919) 570-6160
Fax
(919) 570-6170
NPI assigned
Dec 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2846 NC Primary

Addresses

Primary practice location

12740 Spruce Tree Way
Raleigh, NC 27614-8295

Mailing address

12740 Spruce Tree Way
Raleigh, NC 27614-8295
Phone (919) 570-6160

Other identifiers 4

IdentifierTypeStateIssuer
790201UMedicaidNC
0846VOtherNCBCBS INDIVIDUAL NUMBER
0201UOtherNCBCBS GROUP NUMBER
890846VMedicaidNC

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

State licenses

LicenseStateTypeSpecialty
2846NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Team Chiropractic & Sports Medicine, PA Chiropractor PastSince Jun 1, 1998 Accepting new patients
Aes Medical PC PastSince Nov 25, 2022 Accepting new patients
Dorrance Chiropractic Center Inc Chiropractor PastSince Jan 25, 2010 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1477530061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12740 SPRUCE TREE WAY",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148295",
            "telephone_number": "919-570-6160",
            "fax_number": "919-570-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12740 SPRUCE TREE WAY",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148295",
            "telephone_number": "919-570-6160",
            "fax_number": "919-570-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRILLEY",
        "first_name": "MATTHEW",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790201U",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL NUMBER",
            "identifier": "0846V",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0201U",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890846V",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.