Jill Crossgrove-Murillo, RD
Individual provider Active NPI Registered Dietitian · Wauseon, OH
NPI 1679219984 · NPPES record last updated May 10, 2022
Key facts
- NPI
- 1679219984
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- LD4323 (OH)
- Practice address
- 725 S Shoop Ave
Wauseon, OH 43567-1702 - Phone
- (419) 330-2772
- Fax
- (419) 330-2771
- NPI assigned
- May 10, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- FCHC Medical Care, LLC
Practice addresses (Care Compare)
725 S Shoop Ave
Wauseon, OH 43567-1701
Phone (419) 335-2015
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221118002006 | OH | Practitioner - Registered Dietitian Or Nutrition Professional | 2961882170 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD4323 | OH | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FCHC Medical Care, LLC | Current |
Accepting new patients |
Locations
L3493
Columbus, OH 43260
L4133
Columbus, OH 43260
725 S Shoop Ave
Wauseon, OH 43567
Phone (419) 335-2015
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD4323 | OH | Yes |
Addresses
Primary practice location
725 S Shoop Ave
Wauseon, OH 43567-1702
Mailing address
725 S Shoop Ave
Wauseon, OH 43567-1702
Phone (419) 330-2772
Other providers in Wauseon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.