NPIMap

Individual provider Active NPI

Gary Stephen Crawford, M.D.

  • Family Medicine Physician
  • Wallace, NC
National Provider Identifier
1619963121
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9401162 Issued in NC
Practice address
112 Medical Village Dr
Unit D
Wallace, NC 28466-1668
Phone
(910) 285-7592
Fax
(910) 285-4610
NPI assigned
Sep 21, 2005
Last updated
Jan 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9401162 NC Primary

Addresses

Primary practice location

112 Medical Village Dr
Unit D
Wallace, NC 28466-1668

Mailing address

125 River Vine Pkwy
Wallace, NC 28466-2377
Phone (910) 285-2134

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gcrawford14916@direct.vidanthealth.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080326000403 NC Practitioner - Family Practice 5496831810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

125 River Vine Pkwy
Wallace, NC 28466-2377
Phone (910) 285-2134

401 A N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

401 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

417 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-8080

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9401162NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Jul 1, 2010 Accepting new patients

Locations

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

112 Medical Village Dr
Wallace, NC 28466
Phone (910) 285-7388

112 Medical Village Dr
Ste D
Wallace, NC 28466
Phone (910) 285-7592

125 River Vine Pkwy
Wallace, NC 28466
Phone (910) 285-2134

Interoperability endpoints

  • Direct secure messaging: gcrawford14916@direct.ecuhealth.com
  • Direct secure messaging: gcrawford14916@direct.vidanthealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1619963121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 RIVER VINE PKWY",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284662377",
            "telephone_number": "910-285-2134",
            "fax_number": "910-285-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MEDICAL VILLAGE DR",
            "address_2": "UNIT D",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284661668",
            "telephone_number": "910-285-7592",
            "fax_number": "910-285-4610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAWFORD",
        "first_name": "GARY",
        "middle_name": "STEPHEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9401162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gcrawford14916@direct.vidanthealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2100 Stantonsburg Rd",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278342818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wallace, NC

Sources for this page

Verify at the official NPI Registry.