Active NPI
Jay M. Crutchfield, MD FACS
- Surgery Physician
- Meridian, ID
National Provider Identifier
1700866290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 21253
- Practice address
- 1401 E Central Dr
Meridian, ID 83642-8046 - Phone
- (208) 795-4382
- NPI assigned
- Jan 19, 2006
- Last updated
- Aug 21, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 21253 | AZ | Primary |
Addresses
Primary practice location
1401 E Central Dr
Meridian, ID 83642-8046
Mailing address
1401 E Central Dr
Meridian, ID 83642-8046
Phone (208) 795-4382
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 339756 | Medicaid | AZ | |
| 020041119 | Other | AZ | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21253 | AZ | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597968000000",
"number": "1700866290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 E CENTRAL DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836428046",
"telephone_number": "208-795-4382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 E CENTRAL DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836428046",
"telephone_number": "208-795-4382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUTCHFIELD",
"first_name": "JAY",
"middle_name": "M.",
"credential": "MD FACS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2020-08-21",
"certification_date": "2020-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "21253",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "339756",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020041119",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.