Active NPI
Charles P Crowell III, DO
- Family Medicine Physician
- Hominy, OK
National Provider Identifier
1487623294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1918
- Practice address
- 119 W Main St
Hominy, OK 74035-1031 - Phone
- (918) 885-4640
- Fax
- (918) 885-4644
- NPI assigned
- Mar 15, 2006
- Last updated
- Aug 27, 2013
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1918 | OK | Primary |
Addresses
Primary practice location
119 W Main St
Hominy, OK 74035-1031
Mailing address
212 N Main St
Fairfax, OK 74637-3023
Phone (918) 642-3100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100190910B | Medicaid | OK |
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 Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377561600000",
"number": "1487623294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 N MAIN ST",
"city": "FAIRFAX",
"state": "OK",
"postal_code": "746373023",
"telephone_number": "918-642-3100",
"fax_number": "918-642-5639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 W MAIN ST",
"city": "HOMINY",
"state": "OK",
"postal_code": "740351031",
"telephone_number": "918-885-4640",
"fax_number": "918-885-4644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROWELL",
"first_name": "CHARLES",
"middle_name": "P",
"name_suffix": "III",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-15",
"last_updated": "2013-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "1918",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100190910B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hominy, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.