Crystal Lyne Carradine, DO

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

Practice address

620 John Paul Jones Cir
Portsmouth, VA 23708-2111

Phone

(757) 953-5000

NPI assigned

Apr 29, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1651190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1659016186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6341 KLINES DR",
            "city": "GIRARD",
            "state": "OH",
            "postal_code": "444201260",
            "telephone_number": "330-509-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111",
            "telephone_number": "757-953-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRADINE",
        "first_name": "CRYSTAL",
        "middle_name": "LYNE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-29",
        "last_updated": "2022-12-15",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latwan Carpenter, DR. DHS QMHPA MATC
• Tia Carpenter, CSFA
• Donald Russell Carr Jr., MD
• Elizabeth Ann Carr, D.O.
• Matthew Joseph Carr, M.D.
• Sonja Denise Carraway
• Brent Michael Carreiro, DO
• Christopher Patrick Carroll, M.D.
• Jaimee Lee Carroll, FNP-C
• Steven A. Carroll, D.D.S.

• Military Health Care Provider in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Military Health Care Provider in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.