Crystal Brozovich, PA
Individual provider Active NPI Physician Assistant · Morris, IL
NPI 1740957455 · NPPES record last updated Mar 15, 2024
Key facts
- NPI
- 1740957455
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 1802 N Division St Ste 201
Morris, IL 60450-1183 - Phone
- (815) 513-5625
- NPI assigned
- Aug 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Morris Hospital
Practice addresses (Care Compare)
101 S Prairie Ave
Dwight, IL 60420-1350
Phone (815) 584-3291
1300 Dresden Dr
Morris, IL 60450-2476
Phone (815) 942-5200
1499 Lakewood Dr
Unit 1
Morris, IL 60450-1709
Phone (815) 941-7533
1802 N Division St
Suite 201
Morris, IL 60450-1183
Phone (815) 513-5625
Hospital & facility affiliations
- Morris Hospital & Healthcare Centers
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240328001847 | IL | Practitioner - Physician Assistant | 4284071044 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morris Hospital | Current |
Accepting new patients | |
| Morris Hospital | Current |
Accepting new patients | |
| Morris Hospital | Past | Accepting new patients |
Locations
150 W High St
Morris, IL 60450
Phone (815) 942-2129
1802 N Division St
Ste 201
Morris, IL 60450
Phone (815) 513-5625
725 School St
Ste A
Morris, IL 60450
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
1802 N Division St Ste 201
Morris, IL 60450-1183
Mailing address
725 School St Ste a
Morris, IL 60450-1207
Phone (815) 705-1405
Other practice location 1
1320 W Lombard St
Davenport, IA 52804-2029
Phone (815) 630-1728
Other names
- Crystal Bautista
Other providers in Morris, IL
- John Bolden Jr.
- Bradley R. Lawton, M.D., P.C.
- Brenene Marie Brady
- Jessica Brelje
- Miranda Brennan
- Jennifer Brumfield
- Amy Kathryn Brummel
- Laura Bruyn
- Gail Buehl
- Allison Christine Buldak
All providers in Morris, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.