Individual provider Active NPI

Kelly R Crawford, PA-C

  • Medical Physician Assistant
  • Advance, NC
National Provider Identifier
1801892492
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
103844 Issued in NC
Practice address
108 Dornach Way
Advance, NC 27006-7305
Phone
(336) 940-2407
Fax
(336) 940-2409
NPI assigned
Jun 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 103844 NC Primary

Addresses

Primary practice location

108 Dornach Way
Advance, NC 27006-7305

Mailing address

108 Dornach Way
Advance, NC 27006-7305
Phone (336) 940-2407

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20060927000495 NC Practitioner - Physician Assistant 5092710970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Davie Dermatology, P.a.Group PAC ID 0547241580, 13 clinicians

Practice addresses (Care Compare)

108 Dornach Way
Bermuda Run, NC 27006-7305
Phone (336) 940-2407

Merit-based Incentive Payment System (MIPS)

Final score
94.59 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
81.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
103844NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1801892492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 DORNACH WAY",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270067305",
            "telephone_number": "336-940-2407",
            "fax_number": "336-940-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 DORNACH WAY",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270067305",
            "telephone_number": "336-940-2407",
            "fax_number": "336-940-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAWFORD",
        "first_name": "KELLY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Advance, NC

Sources for this page

Verify at the official NPI Registry.