Individual provider Active NPI

Sean Christopher Crumbock, CRNA

  • Certified Registered Nurse Anesthetist
  • Philadelphia, PA
National Provider Identifier
1689010647
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN596527 Issued in PA
Practice address
111 S 11TH St Ste 8490
Philadelphia, PA 19107-4824
Phone
(215) 955-7000
NPI assigned
May 17, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN596527 PA Primary

Addresses

Primary practice location

111 S 11TH St Ste 8490
Philadelphia, PA 19107-4824

Mailing address

1500 Market St
24TH Floor-West Tower
Philadelphia, PA 19102-2100
Phone (215) 255-3828

Other practice location 1

230 N Broad St
Philadelphia, PA 19102-1121
Phone (215) 762-7922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140812001365 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688891864 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN596527PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Associates in Healthcare, Inc Nurse Anesthetist, Certified Registered CurrentSince Oct 9, 2019 Accepting new patients
Methodist Associates in Healthcare, Inc Current Accepting new patients
Jefferson University Physicians CurrentSince Jan 21, 2020 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Oct 9, 2019 Accepting new patients

Locations

2701 DeKalb Pike
Norristown, PA 19401
Phone (215) 335-6000

2301 S Broad St
Philadelphia, PA 19148
Phone (215) 952-9000

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

111 S 11th St
Ste 8490
Philadelphia, PA 19107
Phone (215) 955-6161

900 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1689010647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MARKET ST",
            "address_2": "24TH FLOOR-WEST TOWER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022100",
            "telephone_number": "215-255-3828",
            "fax_number": "215-255-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST STE 8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191021121",
            "country_code": "US",
            "telephone_number": "215-762-7922",
            "fax_number": "215-762-8656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRUMBOCK",
        "first_name": "SEAN",
        "middle_name": "CHRISTOPHER",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-17",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN596527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.