Charlene Roberta Thompson Criss, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MP00120900 Issued in NJ

Practice address

15 Mohegan Ave
Uscg Academy Clinic
New London, CT 06320

Phone

(860) 701-6737

Fax

(860) 701-6475

NPI assigned

Dec 22, 2005

Last updated

Apr 29, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1760469514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "USCG HQ CG-1121 2703 MLK JR AVE SE MAIL STOP 7907",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "205937907",
            "telephone_number": "202-475-5183",
            "fax_number": "270-294-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MOHEGAN AVE",
            "address_2": "USCG ACADEMY CLINIC",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "06320",
            "telephone_number": "860-701-6737",
            "fax_number": "860-701-6475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Uscg Hq Cg-1121 2703 Mlk Jr Ave SE Mail Stop 7907",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "205937907",
            "country_code": "US",
            "telephone_number": "202-475-5183",
            "fax_number": "270-294-3610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRISS",
        "first_name": "CHARLENE",
        "middle_name": "ROBERTA THOMPSON",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-22",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "1710",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001831",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "MP00120900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS",
            "identifier": "1051820",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT",
            "identifier": "001831",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David F Crawley, M.D.
• Gabrielle Alexis Crawley, BS
• Scott M. Credit, APRN
• Theresa Joan Crino, RPH
• Carmine Raymond Crispino, M.D.
• Patricia Louise Cronin, MD
• Robert Cross, MD
• Andrew D. Crotty, PA-C
• Deirdre A Crowley, LMSW
• Lisa A Crowley, LPC

• Medical Physician Assistant in New London, CT
• Providers in New London, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.

Verify at the official NPI Registry.