NPIMap

Individual provider Active NPI

Crystal Stillwell, NP

  • Primary Care Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1649649773
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
2015027436 Issued in MO
Practice address
2730 E Sunshine St
Springfield, MO 65804-2047
Phone
(417) 883-0600
NPI assigned
Sep 18, 2015
Last updated
Dec 13, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2015027436 MO
Primary Care Nurse Practitioner 363LP2300X 2015027436 MO Primary

Addresses

Primary practice location

2730 E Sunshine St
Springfield, MO 65804-2047

Mailing address

620 S Glenstone Ave
Springfield, MO 65802-3206
Phone (417) 829-4215

Other identifiers 1

IdentifierTypeStateIssuer
1649649773MedicaidMO

Other names 1

  • Crystal Shultz Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20150929002222 MO Practitioner - Nurse Practitioner 3971811647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, 1,121 clinicians

Practice addresses (Care Compare)

2730 E Sunshine St
MC Family Medicine E Sunshine
Springfield, MO 65804-2047
Phone (417) 883-0600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Nov 7, 2016 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Nov 7, 2016 Accepting new patients

Locations

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1235 E Cherokee St
#2D
Springfield, MO 65804
Phone (417) 820-2364

1235 E Cherokee St
Ste 2D
Springfield, MO 65804

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

2730 E Sunshine St
Springfield, MO 65804
Phone (417) 820-9590

620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215

Interoperability endpoints

  • Direct secure messaging: crystal.shultz@cernerdirect.coxhealth.com
  • Direct secure messaging: cshultz772816@directc.mercy.net

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 11

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": "1442534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1649649773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 S GLENSTONE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658023206",
            "telephone_number": "417-829-4215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 E SUNSHINE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042047",
            "telephone_number": "417-883-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLWELL",
        "first_name": "CRYSTAL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-18",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2015027436",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MO",
            "license": "2015027436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649649773",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "SHULTZ",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.