NPIMap

Individual provider Active NPI

Ricardo H Crisostomo, MD

  • Hematology & Oncology Physician
  • Durango, CO
National Provider Identifier
1679533756
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
DR.0067681 Issued in CO
Practice address
1 Mercardo St.
Ste 100
Durango, CO 81301-7306
Phone
(970) 385-7977
Fax
(970) 385-6727
NPI assigned
Mar 24, 2006
Last updated
Jan 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X DR.0067681 CO Primary
Hematology & Oncology Physician 207RH0003X ME89846 FL

Addresses

Primary practice location

1 Mercardo St.
Ste 100
Durango, CO 81301-7306

Mailing address

1 Mercado St Ste 100
Durango, CO 81301-7306
Phone (970) 385-7977

Other practice location 1

801 W Oak St Ste 202
Kissimmee, FL 34741-6609
Phone (407) 500-3627

Other practice location 2

1600 Bundinger Ave
Saint Cloud, FL 34769
Phone (407) 500-3627

Other practice location 3

7350 Sandlake Commons Blvd Ste 2212B
Orlando, FL 32819-8031
Phone (407) 500-3627

Other practice location 4

201 Hilda St
Suite 33
Kissimmee, FL 34741-2320
Phone (407) 483-5836

Other identifiers 1

IdentifierTypeStateIssuer
272461800MedicaidFL

Other names 1

  • Jose Ricardo Crisostomo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, IL, NC3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20051108000607 FL Practitioner - Hematology/Oncology 9436177490 Reassigns benefits to 1 organization
I20230421001317 IL Practitioner - Hematology/Oncology 9436177490 Reassigns benefits to 1 organization
I20250602000097 NC Practitioner - Medical OncologyPractitioner - Internal Medicine 9436177490 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical OncologyAlso: Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 667-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Hematology & Oncology CurrentSince Jan 1, 2010 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Jan 1, 2010 Accepting new patients
NMG Health Services LLC CurrentSince May 9, 2025 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
Novant Health Medical Group Coastal Region, LLC Hematology & Oncology CurrentSince May 9, 2025 Accepting new patients
Physician Services Corporation of Southern Illinois Inc. CurrentSince Apr 12, 2023 Accepting new patients
Florida Cardiology PA Past Accepting new patients
New Hanover Medical Group PA Past Accepting new patients

Locations

201 Hilda St
Ste 33
Kissimmee, FL 34741
Phone (407) 350-3776

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

7350 Sandlake Commons Blvd
Ste 2212B
Orlando, FL 32819
Phone (407) 367-5676

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

4117 Veterans Memorial Dr
Mount Vernon, IL 62864
Phone (618) 241-1827

1333 S Dickinson Dr
Unit 200
Leland, NC 28451
Phone (910) 667-3000

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

Interoperability endpoints

  • Direct secure messaging: rcrisostomo1685176@direct.novanthealth.org
  • Direct secure messaging: rcrisostomo449222@direct-ehr-ssmhc.com

Organizations & group practices 8

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 10

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": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1679533756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MERCADO ST STE 100",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017306",
            "telephone_number": "970-385-7977",
            "fax_number": "970-385-6727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERCARDO ST.",
            "address_2": "STE 100",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017306",
            "telephone_number": "970-385-7977",
            "fax_number": "970-385-6727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 W Oak St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347416609",
            "country_code": "US",
            "telephone_number": "407-500-3627",
            "fax_number": "407-930-4353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 Bundinger Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "FL",
            "postal_code": "34769",
            "country_code": "US",
            "telephone_number": "407-500-3627",
            "fax_number": "407-930-4353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7350 Sandlake Commons Blvd Ste 2212B",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328198031",
            "country_code": "US",
            "telephone_number": "407-500-3627",
            "fax_number": "407-930-4353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 Hilda St",
            "address_2": "Suite 33",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347412320",
            "country_code": "US",
            "telephone_number": "407-483-5836",
            "fax_number": "407-483-5837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRISOSTOMO",
        "first_name": "RICARDO",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CO",
            "license": "DR.0067681",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "FL",
            "license": "ME89846",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272461800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOSE",
            "last_name": "CRISOSTOMO",
            "middle_name": "RICARDO",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Durango, CO

Sources for this page

Verify at the official NPI Registry.