Active NPI
Kevin Crabtree, MSPAS, PA-C
- Medical Physician Assistant
- Berea, KY
National Provider Identifier
1629240304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA1103
- Practice address
- 245 Prince Royal Dr
Suite a
Berea, KY 40403-1471 - Phone
- (859) 986-0375
- Fax
- (859) 986-0305
- NPI assigned
- Apr 2, 2008
- Last updated
- May 22, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA1103 | KY | Primary |
Addresses
Primary practice location
245 Prince Royal Dr
Suite a
Berea, KY 40403-1471
Mailing address
245 Prince Royal Dr
Suite a
Berea, KY 40403-1471
Phone (859) 986-0375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA1103 | KY | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluegrass Clinic Liberty, PLLC | Past | Accepting new patients | |
| 4Seeds Medical Clinic, PLLC | Past | Accepting new patients | |
| Inpatientcare PLLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Primary Care Clinic/Center
- Lancaster, KY
- NPI 1467690198
-
- Family Medicine Physician
- Liberty, KY
- NPI 1457555146
-
- Internal Medicine Physician
- Lexington, KY
- NPI 1821358201
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400716800000",
"number": "1629240304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 PRINCE ROYAL DR",
"address_2": "SUITE A",
"city": "BEREA",
"state": "KY",
"postal_code": "404031471",
"telephone_number": "859-986-0375",
"fax_number": "859-986-0305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 PRINCE ROYAL DR",
"address_2": "SUITE A",
"city": "BEREA",
"state": "KY",
"postal_code": "404031471",
"telephone_number": "859-986-0375",
"fax_number": "859-986-0305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRABTREE",
"first_name": "KEVIN",
"credential": "MSPAS, PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-02",
"last_updated": "2014-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KY",
"license": "PA1103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berea, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.