Keith Thomas Crocker, DO

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

5101007635 Issued in MI

Practice address

4300 Cascade Rd SE
Ste 103
Grand Rapids, MI 49546-3631

Phone

(616) 245-4513

Fax

(616) 245-4802

NPI assigned

Jun 10, 2005

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1871597419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 CASCADE RD SE",
            "address_2": "STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463631",
            "telephone_number": "616-245-4513",
            "fax_number": "616-245-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 CASCADE RD SE",
            "address_2": "STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463631",
            "telephone_number": "616-245-4513",
            "fax_number": "616-245-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKER",
        "first_name": "KEITH",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101007635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P54539",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1683584",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "5413102",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katrina Joyce Cripps
• Katie Crison
• Briana Crist-Burin, LLP
• Cristina Stauffer, LLC
• Paul Critelli, PH.D.
• Lacey Lee Crocker, P.A.
• Alexandra Crockett
• Barbara Croel, RN
• Amy Ann Croff, PA-C
• Emily Patrice Croff

• Orthopaedic Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.