Active NPI
Edgardo Abad Crisostomo, M.D.
- Neurology Physician
- Fargo, ND
National Provider Identifier
1730141466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 31499
- Practice address
- 5225 23Rd Ave S
Fargo, ND 58104 - Phone
- (701) 417-4817
- NPI assigned
- Apr 6, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 31499 | MN | Primary |
Addresses
Primary practice location
5225 23Rd Ave S
Fargo, ND 58104
Mailing address
2120 London Rd Apt 452
Duluth, MN 55812-2811
Phone (218) 310-4128
Other practice location 1
5225 23rd Ave S
Fargo, ND 58104
Phone (701) 417-4817
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 971288700 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Other, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860
Hospital & facility affiliations
- St Lukes Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31499 | MN | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Luke'S Hospital of Duluth | Current | Accepting new patients | |
| St. Luke'S Hospital of Duluth | Current | Accepting new patients | |
| St. Luke'S Hospital of Duluth | Current | Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860
915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352
1120 E 34th St
Hibbing, MN 55746
Phone (218) 362-7100
901 9th St N
Virginia, MN 55792
Phone (218) 741-3340
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Hospital Unit
- Duluth, MN
- NPI 1902845068
-
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Duluth, MN
- NPI 1073480968
-
- General Acute Care Hospital
- Duluth, MN
- NPI 1801835970
Hospital & facility affiliations 26
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Endocrinology, Diabetes & Metabolism Physician
- Duluth, MN
- NPI 1093769796
Hospital
-
- Vascular & Interventional Radiology Physician
- Duluth, MN
- NPI 1124732110
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575331200000",
"number": "1730141466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 LONDON RD APT 452",
"city": "DULUTH",
"state": "MN",
"postal_code": "558122811",
"telephone_number": "218-310-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 23RD AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "58104",
"telephone_number": "701-417-4817"
}
],
"practiceLocations": [
{
"address_1": "5225 23rd Ave S",
"address_purpose": "LOCATION",
"city": "Fargo",
"state": "ND",
"postal_code": "58104",
"country_code": "US",
"telephone_number": "701-417-4817",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CRISOSTOMO",
"first_name": "EDGARDO",
"middle_name": "ABAD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-06",
"last_updated": "2019-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MN",
"license": "31499",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "971288700",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.