Individual provider Active NPI

Brandi Crosson, RD

  • Registered Dietitian
  • Durham, NC
National Provider Identifier
1619605243
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
L006975 Issued in NC
Practice address
2908 Scuppernong LN
Durham, NC 27703-9263
Phone
(919) 793-8994
NPI assigned
Aug 11, 2022
Last updated
Aug 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X L006975 NC Primary

Addresses

Primary practice location

2908 Scuppernong LN
Durham, NC 27703-9263

Mailing address

2908 Scuppernong LN
Durham, NC 27703-9263

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@lifestylemedicalcenters.com RTP Healthy Wellness PLLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230510002094 NC Practitioner - Registered Dietitian Or Nutrition Professional 7416313887 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L006975NCMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Nutrition and Wellness, LLC Dietitian, Registered CurrentSince Dec 29, 2024 Accepting new patients

Locations

5109 Bur Oak Cir
Ste 103
Raleigh, NC 27612
Phone (919) 275-1405

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1619605243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2908 SCUPPERNONG LN",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277039263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 SCUPPERNONG LN",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277039263",
            "telephone_number": "919-793-8994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROSSON",
        "first_name": "BRANDI",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L006975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@lifestylemedicalcenters.com",
            "affiliation": "Y",
            "affiliationName": "RTP Healthy Wellness PLLC",
            "address_1": "10208 Cerny St Ste 206",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276177885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.