Crouch Family Medicine PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

4290 Issued in OK

Legal business name

CROUCH FAMILY MEDICINE PC

Practice address

806 Manvel Ave
Chandler, OK 74834-3858

Phone

(405) 258-9955

Fax

(405) 258-9930

NPI assigned

Apr 18, 2007

Last updated

Mar 4, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Robin Lee Crouch

Title

Business Manager

Phone

(405) 258-9955

Specialties & licenses 1

Addresses

Other identifiers 18

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2867/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason Michael Crouch, D.O.

  • Family Medicine Physician
  • Chandler, OK
  • NPI 1497890115
  Medicare reassignment Care Compare group NPD
• Janena Grace Wilson, FNP

  • Family Nurse Practitioner
  • Chandler, OK
  • NPI 1215222666
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1609093228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 MANVEL AVE",
            "city": "CHANDLER",
            "state": "OK",
            "postal_code": "748343858",
            "telephone_number": "405-258-9955",
            "fax_number": "405-258-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 MANVEL AVE",
            "city": "CHANDLER",
            "state": "OK",
            "postal_code": "748343858",
            "telephone_number": "405-258-9955",
            "fax_number": "405-258-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROUCH FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "CROUCH",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "405-258-9955",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OK",
            "license": "4290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "6147210001",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "9060050",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HEALTH CARE PROVIDER ID #",
            "identifier": "1618242",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA # FOR CROUCH FAMILY MEDICINE LAB (CLIA-WAIVED LAB)",
            "identifier": "37D1067992",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID # FOR JASON CROUCH, D.O.",
            "identifier": "200116520A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200116520A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN FOR JANENA MILBURN, APRN, CNP, FNP-C",
            "identifier": "OKA104243",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PT. B PTAN",
            "identifier": "P00465778",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR JANENA MILBURN, APRN, CNP, FNP-C",
            "identifier": "1215222666",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR JASON CROUCH, D.O. (INDIVIDUAL)",
            "identifier": "1497890115",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE PROVIDER #",
            "identifier": "4474235",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR CROUCH FAMILY MEDICINE (ORGANIZATION)",
            "identifier": "1609093228",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE # FOR JASON CROUCH, D.O.",
            "identifier": "243722101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE # FOR CROUCH FAMILY MEDICINE PC",
            "identifier": "300522328",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID # FOR CROUCH FAMILY MEDICINE PC",
            "identifier": "200116510A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200116510A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME PTAN FOR CROUCH FAMILY MEDICINE",
            "identifier": "6147210001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PT. B GROUP NUMBER",
            "identifier": "DG9878",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Chandler
• Ginger Clark
• Secily Rachelle Cleere
• Megan Coburn, PHARM D
• Richard Allen Covington, D.PH.
• Jason Michael Crouch, D.O.
• Dana D Key, LLC
• Peggy Ann Danker
• Megan Davidson
• Asia Davis

• Primary Care Clinic/Center in Chandler, OK
• Providers in Chandler, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.