Charles Prentice Crumpler, M.D.

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

E6296 Issued in TX

Practice address

709 Hollybrook Dr
Suite 2301
Longview, TX 75605-2411

Phone

(903) 757-5804

Fax

(903) 232-2889

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

89.53 of 100Reported as apm

Quality

79.07

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: charles.crumpler.1@16432.direct.athenahealth.com

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1609986165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19036",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154085",
            "telephone_number": "903-381-7263",
            "fax_number": "903-381-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HOLLYBROOK DR",
            "address_2": "SUITE 2301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052411",
            "telephone_number": "903-757-5804",
            "fax_number": "903-232-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMPLER",
        "first_name": "CHARLES",
        "middle_name": "PRENTICE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TX",
            "license": "E6296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126482208",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "83X183",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charles.crumpler.1@16432.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "direct address",
            "address_1": "709 Hollybrook Dr",
            "address_2": "Suite 2301",
            "city": "Longview",
            "state": "TX",
            "country_code": "US",
            "postal_code": "756052411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Interventional Cardiology Physician in Longview, TX
• Providers in Longview, TX by specialty
• Interventional Cardiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.