Carol D Crisp, PHD, MSN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10002835 Issued in OR

Practice address

3312 Gateway St
Springfield, OR 97477-1054

Phone

(541) 204-4745

NPI assigned

Dec 27, 2006

Last updated

Jul 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Carol D Micsunescu Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nisha Jackson IncGroup PAC ID 6305147745, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carol.crispdnpfnp.p1@direct.opm.nextgenshare.com

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.

• Nisha Jackson PC

  • Nurse Practitioner
  • Medford, OR
  • NPI 1124499124
  Medicare reassignment Care Compare group
• Onepeak Southern Oregon PC

  • Family Medicine Physician
  • Medford, OR
  • NPI 1740917558
  Medicare reassignment NPD

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1689730616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3265 HILLCREST PARK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047657",
            "telephone_number": "541-275-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 GATEWAY ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771054",
            "telephone_number": "541-204-4745"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1075 N Curtis Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837061348",
            "country_code": "US",
            "telephone_number": "208-377-5166",
            "fax_number": "208-375-0599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRISP",
        "first_name": "CAROL",
        "middle_name": "D",
        "credential": "PHD, MSN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "CNP61599",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10002835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "CNP61599",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "10002835",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "MICSUNESCU",
            "middle_name": "D",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Page M Crenshaw, FNP
• Katherine Eva Crenwelge, MD
• Elizabeth Creps, LMT
• Cris Dental Group
• Jessica Criser, APRN
• Robert Crisp, RN
• Carol L Crocker, FNP
• Jason Daniel Cronin, M.D.
• Desmond A Crooks, MD
• Kathryn R Cross, MS CCC SLP

• Family Nurse Practitioner in Springfield, OR
• Providers in Springfield, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.