NPIMap

Individual provider Active NPI

Crystal Renee Stafford, FNP-C

  • Family Nurse Practitioner
  • Wiggins, MS
National Provider Identifier
1851816797
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
902087 Issued in MS
Practice address
975 Hall St
Wiggins, MS 39577-2107
Phone
(601) 528-9119
NPI assigned
Aug 12, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F06171077 MS
Family Nurse Practitioner 363LF0000X 902087 MS Primary

Addresses

Primary practice location

975 Hall St
Wiggins, MS 39577-2107

Mailing address

PO Box 1007
Lucedale, MS 39452-1007
Phone (601) 528-9119

Other practice location 1

4215 15th St
Gulfport, MS 39501-2523
Phone (228) 863-5211

Other identifiers 1

IdentifierTypeStateIssuer
902087OtherMSMS MEDICAL LICENSURE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171214001190 MS Practitioner - Nurse Practitioner 6800154113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wiggins Primary CareGroup PAC ID 5890737019, 7 clinicians

Practice addresses (Care Compare)

975 Hall St
Wiggins, MS 39577-2107
Phone (601) 947-8181

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F06171077MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
George County Hospital Current Accepting new patients
Wiggins Primary Care CurrentSince Jan 5, 2018 Accepting new patients

Locations

975 Hall St
Wiggins, MS 39577
Phone (601) 528-9119

Interoperability endpoints

  • Direct secure messaging: crystalstafford@communitym.allscriptsdirect.net
  • Direct secure messaging: crystalstafford@grh.medalliesdirect.net

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

Hospital & facility affiliations 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1502496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1851816797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1007",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394521007",
            "telephone_number": "601-528-9119",
            "fax_number": "601-947-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 HALL ST",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395772107",
            "telephone_number": "601-528-9119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4215 15th St",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "395012523",
            "country_code": "US",
            "telephone_number": "228-863-5211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "CRYSTAL",
        "middle_name": "RENEE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-12",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "F06171077",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS MEDICAL LICENSURE",
            "identifier": "902087",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wiggins, MS

Sources for this page

Verify at the official NPI Registry.