Crystal Medical Care,P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

223041 Issued in NY

Legal business name

CRYSTAL MEDICAL CARE,P.C.

Practice address

6914 41St Ave
Ste C1
Woodside, NY 11377-4028

Phone

(718) 803-6300

Fax

(718) 803-2434

NPI assigned

Mar 3, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Vishwanath Valagerehally Puttaswamygowda, M.D.,NPI 1710118435

Title

President

Phone

(718) 803-6300

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GBADBA

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vishwanath Valagerehally Puttaswamygowda, MD

  • Internal Medicine Physician
  • Woodside, NY
  • NPI 1710118435
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1299110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493078400000",
    "number": "1689972317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6914 41ST AVE",
            "address_2": "STE C1",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113774028",
            "telephone_number": "718-803-6300",
            "fax_number": "718-803-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6914 41ST AVE",
            "address_2": "STE C1",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113774028",
            "telephone_number": "718-803-6300",
            "fax_number": "718-803-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL MEDICAL CARE,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-03",
        "last_updated": "2017-04-25",
        "status": "A",
        "authorized_official_last_name": "PUTTASWAMYGOWDA",
        "authorized_official_first_name": "VISHWANATH",
        "authorized_official_middle_name": "VALAGEREHALLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-803-6300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "223041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03260455",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Woodside, NY
• Providers in Woodside, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.