Todd M Kreykes, PA.C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

069428 Issued in MI

Practice address

4713 Pine St SW
South Boardman, MI 49680-9761

Phone

(231) 369-2656

Fax

(231) 369-2662

NPI assigned

Dec 7, 2005

Last updated

Dec 11, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Boardman Family Practice PLLC

  • Rural Health Clinic/Center
  • South Boardman, MI
  • NPI 1740564681
  Authorized official Same address or phone
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355184000000",
    "number": "1750366308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "SOUTH BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-369-2656",
            "fax_number": "231-369-2662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "SOUTH BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-369-2656",
            "fax_number": "231-369-2662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREYKES",
        "first_name": "TODD",
        "middle_name": "M",
        "credential": "PA.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2012-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "069428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boardman Family Practice PLLC
• Boardman Health and Wellness, PLLC
• Katelyn R. Crain
• Rachel Lynn Johnson
• Restorative Outdoor Services LLC

• Physician Assistant in South Boardman, MI
• Providers in South Boardman, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.