Crystal D Rucker, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

461 Issued in WV

Practice address

725 N Pike St
Grafton, WV 26354-1270

Phone

(304) 265-4909

Fax

(304) 265-4915

NPI assigned

Sep 20, 2006

Last updated

Feb 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Grafton City Hospital Inc

  • General Practice Physician
  • Grafton, WV
  • NPI 1033264387
  Medicare reassignment
• Preston Taylor Community Health Centers, Incorporated

  dba Mt. Storm Health Center

  • Federally Qualified Health Center (FQHC)
  • Mount Storm, WV
  • NPI 1700819471
  Medicare reassignment
• Grafton City Hospital Inc

  • Critical Access Hospital
  • Grafton, WV
  • NPI 1265484893
  NPD
• Preston Taylor Community Health Centers, Incorporated

  dba Community Eye Care

  • Federally Qualified Health Center (FQHC)
  • Grafton, WV
  • NPI 1871365304
  NPD
• Preston Taylor Community Health Centers, Incorporated

  dba Medical Center of Taylor County

  • Federally Qualified Health Center (FQHC)
  • Grafton, WV
  • NPI 1992813604
  NPD
• Preston-Taylor Community Health Centers Incorporated

  dba Rowlesburg Clinic

  • Federally Qualified Health Center (FQHC)
  • Rowlesburg, WV
  • NPI 1093729857
  NPD
• Preston Taylor Community Health Centers, Incorporated

  dba Mountaintop Health Center

  • Federally Qualified Health Center (FQHC)
  • Thomas, WV
  • NPI 1245348945
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1699873257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35",
            "city": "NEWBURG",
            "state": "WV",
            "postal_code": "264100035",
            "telephone_number": "304-892-2828",
            "fax_number": "304-892-2927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 N PIKE ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541270",
            "telephone_number": "304-265-4909",
            "fax_number": "304-265-4915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2060 N Mountaineer Hwy",
            "address_purpose": "LOCATION",
            "city": "Newburg",
            "state": "WV",
            "postal_code": "264108994",
            "country_code": "US",
            "telephone_number": "304-892-2812",
            "fax_number": "304-892-2814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUCKER",
        "first_name": "CRYSTAL",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3910005605",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rhonda L Roby
• Donetta Amy Rodriguez
• Monica Denise Rogers, SLP
• Chrystle Dawn Rose
• Rosewood Center Opco, LLC (Rosewood Center Post Acute)
• Linda Sapp
• Lisa Sapp
• Natalie Satterfield
• Melissa Kay Schmuck
• Wanda Mae Schmuck

• Physician Assistant in Grafton, WV
• Providers in Grafton, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.