Punyacha Chuanchom Crocker, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

4704278307 Issued in MI

Practice address

1500 East Medical Center Drive
B1 Floor Taubman Center Recp Mos Room 126
Ann Arbor, MI 48109-5317

Phone

(734) 232-2867

NPI assigned

Dec 22, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Punyacha Chuanchom Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Regents of the University of Michigan

  • Nurse Practitioner
  • Ann Arbor, MI
  • NPI 1447275102
  Medicare reassignment Care Compare group NPD
• Regents of the University of Michigan

  • Specialty Pharmacy
  • Dexter, MI
  • NPI 1952181919
  NPD
• Telemed Consultants PLLC

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1699398347
  NPD (past)

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

• Regents of the University of Michigan

  • General Acute Care Hospital
  • Ann Arbor, MI
  • NPI 1003878539
  Care Compare affiliation

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1801294020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 SOUTH STATE STREET",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DRIVE",
            "address_2": "B1 FLOOR TAUBMAN CENTER RECP MOS ROOM 126",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095317",
            "telephone_number": "734-232-2867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKER",
        "first_name": "PUNYACHA",
        "middle_name": "CHUANCHOM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-22",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704278307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PUNYACHA",
            "last_name": "CHUANCHOM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kellie Cripe, LMSW
• Halley Patricia Haver Crissman, MD
• Jessica Cristiu, MD
• Amber J Cristman, PTA
• Erica Kristyne Crittendon, MD
• Melisa Croley
• Rosanne Crompton, PHYSICAL THERAPIST
• Daniel Thomas Cronin, M.D.
• Paul Cronin, MB, BCH, BAO
• Tyler Cronin

• Acute Care Nurse Practitioner in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Acute Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.