Active NPI
Mary Cracium, DO
- Family Medicine Physician
- Marysville, MI
National Provider Identifier
1790750685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101006996
- Practice address
- 1985 Gratiot Blvd
Suite 2a
Marysville, MI 48040-2215 - Phone
- (810) 364-5050
- Fax
- (810) 364-5688
- NPI assigned
- Feb 22, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101006996 | MI | Primary |
Addresses
Primary practice location
1985 Gratiot Blvd
Suite 2a
Marysville, MI 48040-2215
Mailing address
1985 Gratiot Blvd
Suite 2a
Marysville, MI 48040-2215
Phone (810) 364-5050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4388505 | Medicaid | MI | |
| 4737867 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vpa PC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Fort Gratiot, MI
- NPI 1962516286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295222400000",
"number": "1790750685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1985 GRATIOT BLVD",
"address_2": "SUITE 2A",
"city": "MARYSVILLE",
"state": "MI",
"postal_code": "480402215",
"telephone_number": "810-364-5050",
"fax_number": "810-364-5688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1985 GRATIOT BLVD",
"address_2": "SUITE 2A",
"city": "MARYSVILLE",
"state": "MI",
"postal_code": "480402215",
"telephone_number": "810-364-5050",
"fax_number": "810-364-5688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRACIUM",
"first_name": "MARY",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-22",
"last_updated": "2011-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101006996",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4388505",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4737867",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marysville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.