Crown City Medical Group Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROWN CITY MEDICAL GROUP INC.

Practice address

3208 Santa Anita Ave
# 200
El Monte, CA 91733-1360

Phone

(626) 454-1990

Fax

(626) 454-1995

NPI assigned

Apr 6, 2007

Last updated

Aug 22, 2020By 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

Maureen B. Tyson

Title

Ceo

Phone

(626) 798-8792

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619090610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 SANTA ANITA AVE",
            "address_2": "# 200",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917331360",
            "telephone_number": "626-454-1990",
            "fax_number": "626-454-1995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 SANTA ANITA AVE",
            "address_2": "# 200",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917331360",
            "telephone_number": "626-454-1990",
            "fax_number": "626-454-1995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN CITY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-798-8792"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER #",
            "identifier": "GR0041812",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shalonda Katrice Crawford, PSYD
• Crispina a. Chen, M.D., Inc.
• Ana Lydia Cristobal, M.S.
• Jennifer A Crotteau
• Eric Daniel Crowder II
• Gisselle Cruz
• Isabel Cruz, MSW
• Jennifer Cruz
• Patricia Cruz, CATC
• CVS

• Family Medicine Physician in El Monte, CA
• Providers in El Monte, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.