NPIMap

Individual provider Active NPI

Crystal Lisa Rene de Cotret, MPAP, PA-C

  • Surgical Physician Assistant
  • Long Beach, CA
National Provider Identifier
1780982819
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA21595 Issued in CA
Practice address
3828 Schaufele Ave Ste 340
Long Beach, CA 90808-1793
Phone
(657) 241-9052
Fax
(714) 665-4663
NPI assigned
Mar 15, 2011
Last updated
Aug 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA21595 CA Primary

Addresses

Primary practice location

3828 Schaufele Ave Ste 340
Long Beach, CA 90808-1793

Mailing address

3828 Schaufele Ave Ste 340
Long Beach, CA 90808-1793
Phone (657) 241-9052

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110914000703 CA Practitioner - Physician Assistant 3476724840 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Southern California Keck School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210

20101 Lake Chabot Rd
Castro Valley, CA 94546-5305
Phone (510) 886-3400

20103 Lake Chabot Rd
Castro Valley, CA 94546-5305
Phone (510) 727-3256

3200 Kearney St
Fremont, CA 94538-2299
Phone (510) 490-1222

350 Hawthorne Ave
Oakland, CA 94609-3108
Phone (510) 655-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.17 of 100Reported as group
Quality
81.15
Promoting interoperability
100
Improvement activities
40
Cost
71.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA21595CAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
California Wound & Hyperbaric Specialists Inc CurrentSince Oct 20, 2025 Accepting new patients
Providence Medical Foundation CurrentSince Oct 27, 2025 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Feb 1, 2025 Accepting new patients
Providence Medical Foundation CurrentSince Oct 27, 2025 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Feb 1, 2025 Accepting new patients
Dignity Health Past Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Ahmc San Gabriel Valley Medical Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Providence Medical Foundation Past Accepting new patients
Robert L Shuman MD Inc PastSince Oct 17, 2021 Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients

Locations

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

2255 Morello Ave
Ste 121
Pleasant Hill, CA 94523
Phone (510) 224-6556

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 525-5300

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: crenedecotret706420@hisp.ehr.sutterhealth.org
  • Direct secure messaging: crenedecotretmedstu81335@direct.memorialcare.org

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1780982819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3828 SCHAUFELE AVE STE 340",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908081793",
            "telephone_number": "657-241-9052",
            "fax_number": "714-665-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3828 SCHAUFELE AVE STE 340",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908081793",
            "telephone_number": "657-241-9052",
            "fax_number": "714-665-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENE DE COTRET",
        "first_name": "CRYSTAL",
        "middle_name": "LISA",
        "name_prefix": "Ms.",
        "credential": "MPAP, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-15",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA21595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.