Guillermo V Crisologo, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35-032803 Issued in OH

Practice address

620 Jefferson St
Port Clinton, OH 43452-2413

Phone

(419) 734-3116

Fax

(419) 734-5786

NPI assigned

Aug 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Coshocton Surgical Clinic

  • Surgery Physician
  • Coshocton, OH
  • NPI 1538100979
  NPD (past)

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821106295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 JEFFERSON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434522413",
            "telephone_number": "419-734-3116",
            "fax_number": "419-734-5786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 JEFFERSON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434522413",
            "telephone_number": "419-734-3116",
            "fax_number": "419-734-5786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISOLOGO",
        "first_name": "GUILLERMO",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-032803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS OF OHIO",
            "identifier": "25500",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0157397",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Covenant Care Ohio, Inc.
• Barry Reed Cover, M.D.
• Breanne Crawford
• Emma Rose Crawford
• Haley Crawford
• Maria Suzanne Crosser
• Taylor Crum, LSW, LICDC
• Daniel G Cadigan MD Inc
• Joseph A Darr, DC
• Kirra Jean Day, LPT

• Surgery Physician in Port Clinton, OH
• Providers in Port Clinton, OH by specialty
• Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.