Active NPI
Michael E Criswell, CNS
- Medical-Surgical Clinical Nurse Specialist
- Lafayette, IN
National Provider Identifier
1679977128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical-Surgical Clinical Nurse Specialist
- License
- 28074750A
- Practice address
- 1500 Salem St
Lafayette, IN 47904-2164 - Phone
- (765) 448-8000
- NPI assigned
- Oct 13, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical-Surgical Clinical Nurse Specialist | 364SM0705X | 28074750A | IN | Primary |
Addresses
Primary practice location
1500 Salem St
Lafayette, IN 47904-2164
Mailing address
PO Box 5545
Lafayette, IN 47903-5545
Phone (765) 448-8000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000905209 | Other | IN | ANTHEM PROVIDER NUMBER |
| 201262580 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mcriswe2@iuhealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28074750A | IN | MD | Medical-Surgical Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1679977128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5545",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479035545",
"telephone_number": "765-448-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 SALEM ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042164",
"telephone_number": "765-448-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRISWELL",
"first_name": "MICHAEL",
"middle_name": "E",
"credential": "CNS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-13",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "364SM0705X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Medical-Surgical",
"state": "IN",
"license": "28074750A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "000000905209",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201262580",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mcriswe2@iuhealth.org",
"affiliation": "N",
"address_1": "1500 Salem St",
"city": "Lafayette",
"state": "IN",
"country_code": "US",
"postal_code": "479042164",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.