Lisa D Crutcher, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-104449 Issued in IL

Practice address

1830 Mediterranean Dr
Sycamore, IL 60178-3144

Phone

(815) 306-2700

Fax

(815) 306-2715

NPI assigned

Jan 27, 2006

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 identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 29, 2021 through Nov 29, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lisa.crutcher@14761201434628.direct.elationemr.com

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.

• KSB Medical Group, Inc.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1073592119
  NPD (past)
• KSB Medical Group, Inc.

  dba KSB Optical

  • Eyewear Supplier
  • Dixon, IL
  • NPI 1306814603
  NPD (past)

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1841261013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 MEDITERRANEAN DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783144",
            "telephone_number": "815-306-2700",
            "fax_number": "815-306-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 MEDITERRANEAN DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783144",
            "telephone_number": "815-306-2700",
            "fax_number": "815-306-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUTCHER",
        "first_name": "LISA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-104449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "920540044",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104449",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (GROUP)",
            "identifier": "920540",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cpo Services, Inc. (Comprehensive Prosthetics and Orthotics)
• Jamieson T Credille, DPT
• Starline Rose Crouch, M.A. CCC-SLP
• Mackenzie Crowell
• John Ward Crown, DMD
• Elizabeth Jean Cunningham, LCSW
• Kay E Currey, DDS
• Curtis E. Lang, D.D.S. (Courtview Dental Center)
• Jolene F. Curtis, LCSW
• Todd Alan Curtis, DDS, MS, MS

• Family Medicine Physician in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.