NPIMap

Organization Active NPI

Crescent Internal Medicine Group, LLC

  • Internal Medicine Physician
  • Montclair, NJ
National Provider Identifier
1790886885
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MB071292 Issued in NJ
Legal business name
CRESCENT INTERNAL MEDICINE GROUP, LLC
Practice address
29 The Crescent
Montclair, NJ 07042-2636
Phone
(973) 783-0800
Fax
(973) 744-1274
NPI assigned
Sep 25, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Edward Todd Krupp, D.O.NPI 1760583868
Title
Owner/Physician
Phone
(973) 783-0800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MB071292 NJ Primary

Addresses

Primary practice location

29 The Crescent
Montclair, NJ 07042-2636

Mailing address

29 The Crescent
Montclair, NJ 07042-2636
Phone (973) 783-0800

Other identifiers 1

IdentifierTypeStateIssuer
P00059104OtherNJRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040511001220 NJ Part B Supplier - Clinic/Group Practice 8628067931 Receives reassigned benefits from 2 practitioners
Practice locations: Montclair, NJ

National Provider Directory

National Provider Directory

Locations

29 The Cres
Montclair, NJ 07042
Phone (732) 442-8185

98 Park St
Montclair, NJ 07042
Phone (973) 783-0800

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1790886885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 THE CRESCENT",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422636",
            "telephone_number": "973-783-0800",
            "fax_number": "973-744-1274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 THE CRESCENT",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422636",
            "telephone_number": "973-783-0800",
            "fax_number": "973-744-1274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT INTERNAL MEDICINE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KRUPP",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "973-783-0800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB071292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00059104",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.