Individual provider Active NPI

Vincent G Crump, DPM

  • Podiatrist
  • Brandon, FL
National Provider Identifier
1629044870
Registry record updated Aug 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO2083 Issued in FL
Practice address
1735 Brandon Trace Ave
Brandon, FL 33510-2027
Phone
(813) 416-0207
Fax
(813) 881-9118
NPI assigned
Feb 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PO2083 FL Primary

Addresses

Primary practice location

1735 Brandon Trace Ave
Brandon, FL 33510-2027

Mailing address

1735 Brandon Trace Ave
Brandon, FL 33510-2027
Phone (813) 416-0207

Other identifiers 1

IdentifierTypeStateIssuer
340200200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031216000844 FL Practitioner - PodiatryPractitioner - Diagnostic Radiology 8224935465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1155 N Jefferson St
Monticello, FL 32344-2246
Phone (850) 342-0242

1735 Brandon Trace Ave
Brandon, FL 33510-2027
Phone (813) 881-9118

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
V C Podiatry PA Podiatrist CurrentSince Jan 1, 2006 Accepting new patients

Locations

12180 28th St N
St Petersburg, FL 33716
Phone (727) 540-9049

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249948800000",
    "number": "1629044870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 BRANDON TRACE AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335102027",
            "telephone_number": "813-416-0207",
            "fax_number": "813-881-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 BRANDON TRACE AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335102027",
            "telephone_number": "813-416-0207",
            "fax_number": "813-881-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMP",
        "first_name": "VINCENT",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2009-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO2083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340200200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.