NPIMap

Individual provider Active NPI

Mary Beth Crabtree, PA-C

  • Medical Physician Assistant
  • Columbia, KY
National Provider Identifier
1700196425
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA1582 Issued in KY
Practice address
197 Will Walker Rd
Columbia, KY 42728-7436
Phone
(270) 384-9981
Fax
(270) 384-9989
NPI assigned
Oct 15, 2010
Last updated
Oct 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1582 KY Primary

Addresses

Primary practice location

197 Will Walker Rd
Columbia, KY 42728-7436

Mailing address

PO Box 1080
Burkesville, KY 42717-1080
Phone (270) 858-6655

Other identifiers 2

IdentifierTypeStateIssuer
7100149200MedicaidKY
13578821OtherCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101122000288 KY Practitioner - Physician Assistant 8628264280 Reassigns benefits to 2 organizations
I20241219004214 TN Practitioner - Physician Assistant 8628264280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

102 Rhodes St
Gamaliel, KY 42140-8942
Phone (270) 457-3000

197 Will Walker Rd
Columbia, KY 42728-7436
Phone (270) 384-9981

360 Keen St
Burkesville, KY 42717-7915
Phone (270) 864-2889

PO Box
Burkesville, KY 42717

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3881TNMDSpeech-Language Pathologist
PA1582KYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Sep 26, 2024 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Sep 26, 2024 Accepting new patients
Cumberland Family Medical Center Inc CurrentSince Sep 16, 2015 Accepting new patients
Cumberland Family Medical Center Inc CurrentSince Sep 16, 2015 Accepting new patients
Cumberland Family Medical Center Inc Past Accepting new patients

Locations

360 Keen St
Burkesville, KY 42717
Phone (270) 864-1472

197 Will Walker Rd
Columbia, KY 42728
Phone (270) 384-9981

Interoperability endpoints

  • Direct secure messaging: mary.crabtree.1@28997.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1700196425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-858-6655",
            "fax_number": "270-858-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 WILL WALKER RD",
            "city": "COLUMBIA",
            "state": "KY",
            "postal_code": "427287436",
            "telephone_number": "270-384-9981",
            "fax_number": "270-384-9989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRABTREE",
        "first_name": "MARY",
        "middle_name": "BETH",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2023-10-12",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA1582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100149200",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13578821",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, KY

Sources for this page

Verify at the official NPI Registry.