David Bruce Crandall Jr., D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

02003945 Issued in IN

Practice address

11050 Mount Belvedere Blvd
USA Meddac, Attn: Credentials
Fort Drum, NY 13602-5004

Phone

(315) 772-4025

Fax

(315) 772-9498

NPI assigned

Aug 5, 2006

Last updated

Dec 20, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit Medical Group, LLC

  dba Aligned Providers of Wyoming

  • Emergency Medicine Physician
  • Cheyenne, WY
  • NPI 1457802993
  Medicare reassignment NPD
• Icem-Ball, LLC

  • Emergency Medicine Physician
  • Muncie, IN
  • NPI 1316273691
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324339200000",
    "number": "1811906522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "address_2": "USA MEDDAC, ATTN: CREDENTIALS",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025004",
            "telephone_number": "315-772-4025",
            "fax_number": "315-772-9498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "address_2": "USA MEDDAC, ATTN: CREDENTIALS",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025004",
            "telephone_number": "315-772-4025",
            "fax_number": "315-772-9498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRANDALL",
        "first_name": "DAVID",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "1993",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02003945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janelle Lynn Cordova, PA-C
• Andrew David Cornelison, PA-C
• Kristen Cornett
• Jeffrey Morgan Cox, LICSW
• Linda Cox, DENTAL ASSISTANTEFDA
• Edan Critchfield, PSYD
• Steven Colton Crowther, O.D.
• Doreen Hendrie Crumpton
• Travis Dean Cudlin, RD
• Peter Leo Cuff, D.O.

• Emergency Medicine Physician in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.