Andre D Crockett, NMD

Primary specialty

NaturopathTaxonomy code 175F00000X

Practice address

3075 Book Rd Ste 103
Naperville, IL 60567-1401

Phone

(630) 442-8749

NPI assigned

Jun 24, 2020

Sex

Male

Sole proprietor

No

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.

• Crockett Wellness Clinic LLC

  • Clinic/Center
  • Naperville, IL
  • NPI 1487300935
  NPD Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 24, 2020.

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1659997690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 STONEWATER DR",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605644881",
            "telephone_number": "331-213-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 BOOK RD STE 103",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605671401",
            "telephone_number": "630-442-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "ANDRE",
        "middle_name": "D",
        "credential": "NMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-24",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "570089658@qliq.com",
            "affiliation": "N",
            "endpointDescription": "Qliq ID",
            "address_1": "3075 Book Rd Ste 103",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605671401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "570089658@qliqsoft.com",
            "affiliation": "N",
            "address_1": "3075 Book Rd Ste 103",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605671401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Crescent Primary Care Physicians PC
• Maximino Crespo-Deynes, L.P.C.
• Mary Ayres Crissman, B.S.
• Taniyah J Criswell, RBT
• Crockett Wellness Clinic LLC
• Timothy Noel Crombie, D.D.S.
• Crossroads Community Counseling
• Stephen C Crotty, M.D.
• Gina Mercedes Crovetti, LCPC
• Jasmin Rebeca Cruz

• All providers in Naperville, IL
• Naturopath in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.