Crystal Community E N T

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

OS5716 Issued in FL

Legal business name

CRYSTAL COMMUNITY E N T

Practice address

790 SE 5TH Ter
Crystal River, FL 34429-4852

Phone

(352) 795-0011

Fax

(352) 795-9481

NPI assigned

Mar 27, 2007

Last updated

Sep 11, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly Surrency

Title

Office Manager

Phone

(352) 795-0011

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Denis Walter Grillo, D.O.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Crystal River, FL
  • NPI 1235127937
  Medicare reassignment NPD
• Angela Schenk, AU.D.

  • Audiologist
  • Crystal River, FL
  • NPI 1154592293
  Medicare reassignment NPD
• Cynthia L Amundson, M.S.

  • Audiologist
  • Spring Hill, FL
  • NPI 1982870952
  NPD (past)

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536624000000",
    "number": "1669590790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 SE 5TH TER",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344294852",
            "telephone_number": "352-795-0011",
            "fax_number": "352-795-9481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 SE 5TH TER",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344294852",
            "telephone_number": "352-795-0011",
            "fax_number": "352-795-9481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL COMMUNITY E N T",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2018-09-11",
        "status": "A",
        "authorized_official_last_name": "SURRENCY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "352-795-0011",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "FL",
            "license": "OS5716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCR GROUP#",
            "identifier": "DA5520",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00062969",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "200691",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "80221",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED MINE WORKERS",
            "identifier": "1409549",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Craig W Englund MD PA (Citrus Hematology & Oncology Center)
• CRC, Inc (Don's Pharmacy)
• Rebecca Cretty
• Carrie Crochetiere
• Gerilyn E. Cross, M.D.
• Crystal Gem Manor
• Crystal Gem Manor
• Crystal Home Medical Equipment Inc
• Crystal Palace Senior Living LLC
• Crystal River Anesthesia Associates, LLC

• Otolaryngology/Facial Plastic Surgery Physician in Crystal River, FL
• Providers in Crystal River, FL by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.