Carly Elizabeth Crull

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

4704291722 Issued in MI

Practice address

44405 Woodward Ave
Pontiac, MI 48341-5023

Phone

(248) 858-3000

NPI assigned

Mar 3, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• CH MSSP Services Mi PLLC

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1609569169
  Medicare reassignment NPD
• SJMH Medical Practice-SMHC

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1346284684
  Medicare reassignment NPD
• SJMH Medical Practice-SMHC

  • Urgent Care Clinic/Center
  • Waterford, MI
  • NPI 1366644551
  NPD

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

{
    "created_epoch": "1551571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551571200000",
    "number": "1578021135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3430 FARMERS CREEK RD",
            "city": "METAMORA",
            "state": "MI",
            "postal_code": "484559791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44405 WOODWARD AVE",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415023",
            "telephone_number": "248-858-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRULL",
        "first_name": "CARLY",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-03",
        "last_updated": "2019-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704291722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alisa Cretu
• Susan Crim
• Paul D Croissant, M.D.
• Antwan Croom
• Ashley Crowder, MA, LLPC
• Wendy R Crusoe
• Mariela Cruz Rodriguez
• Vanessa Cruz
• Yolanda Lee Cunningham
• Aleta Blanche Curry, LLPC

• Primary Care Nurse Practitioner in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2019; 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.

Verify at the official NPI Registry.