K. Thomas Crocker, D.O., P.C.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

5101007635 Issued in MI

Legal business name

K. THOMAS CROCKER, D.O., P.C.

Practice address

4300 Cascade Rd SE
Suite 103
Grand Rapids, MI 49546-3631

Phone

(616) 245-4513

Fax

(616) 245-4802

NPI assigned

Dec 20, 2007

Organization subpart

No

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

Authorized official

Name

Kerri S Thompson

Title

Office Manager

Phone

(616) 245-4513

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1639353071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 CASCADE RD SE",
            "address_2": "SUITE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463631",
            "telephone_number": "616-245-4513",
            "fax_number": "616-245-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 CASCADE RD SE",
            "address_2": "SUITE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463631",
            "telephone_number": "616-245-4513",
            "fax_number": "616-245-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K. THOMAS CROCKER, D.O., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "KERRI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "616-245-4513"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101007635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1683584",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; 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.