Active NPI
Michele Crosmer, RD
- Registered Dietitian
- Upland, CA
National Provider Identifier
1699133090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86014375
- Practice address
- 123 E 9TH St
Ste 320
Upland, CA 91786-6023 - Phone
- (909) 912-4060
- Fax
- (888) 974-4248
- NPI assigned
- Feb 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86014375 | CA | Primary |
Addresses
Primary practice location
123 E 9TH St
Ste 320
Upland, CA 91786-6023
Mailing address
8431 Hawthorne St
Alta Loma, CA 91701-4544
Phone (909) 912-4060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2021 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86014375 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1699133090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8431 HAWTHORNE ST",
"city": "ALTA LOMA",
"state": "CA",
"postal_code": "917014544",
"telephone_number": "909-912-4060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 E 9TH ST",
"address_2": "STE 320",
"city": "UPLAND",
"state": "CA",
"postal_code": "917866023",
"telephone_number": "909-912-4060",
"fax_number": "888-974-4248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROSMER",
"first_name": "MICHELE",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-01",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86014375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.