Active NPI
Jeremiah Jacob Crank, M.D.
- Internal Medicine Physician
- Longview, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD60315265
- Practice address
- 1615 Delaware St
Longview, WA 98632-2367 - Phone
- (360) 501-3601
- Fax
- (360) 501-3648
- NPI assigned
- Apr 1, 2008
- Last updated
- Feb 16, 2017
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD60315265 | WA | Primary |
Addresses
Primary practice location
1615 Delaware St
Longview, WA 98632-2367
Mailing address
1115 SE 164TH Ave
Dept. 358
Vancouver, WA 98683-9324
Phone (360) 729-1462
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2024337 | Medicaid | WA | |
| 500715191 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Oregon Health Sciences University School of Medicine, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1615 Delaware St
Longview, WA 98632-2367
Phone (360) 636-4814
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD60315265 | WA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth | Internal Medicine | Current | Accepting new patients |
| Peacehealth | Past | Accepting new patients |
Locations
1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818
1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253
Interoperability endpoints
- jcrank323080@direct.peacehealth.org
Organizations & group practices 2
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.
-
dba St. John Medical Center - PeaceHealth Medical Group
- Multi-Specialty Clinic/Center
- Longview, WA
- NPI 1720056187
Internal Medicine
-
dba St. John Medical Center - Outpatient Therapy
- Physical Therapist
- Longview, WA
- NPI 1275501538
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Assured Home Health & Hospice
- Home Health Agency
- Centralia, WA
- NPI 1154397305
-
dba PeaceHealth SW Heart & Vascular Center
- Cardiovascular Disease Physician
- Vancouver, WA
- NPI 1003194911
Hospital
-
dba PeaceHealth Southwest Medical Center
- General Acute Care Hospital
- Vancouver, WA
- NPI 1134178999
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487203200000",
"number": "1528230323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 SE 164TH AVE",
"address_2": "DEPT. 358",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986839324",
"telephone_number": "360-729-1462",
"fax_number": "360-729-3104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 DELAWARE ST",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322367",
"telephone_number": "360-501-3601",
"fax_number": "360-501-3648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRANK",
"first_name": "JEREMIAH",
"middle_name": "JACOB",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-01",
"last_updated": "2017-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD60315265",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2024337",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500715191",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.