Kevin Crisham, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

12209 Issued in AZ

Practice address

8836 N 23Rd Ave
B1
Phoenix, AZ 85021-4185

Phone

(602) 944-9810

Fax

(602) 216-7040

NPI assigned

Feb 29, 2008

Sex

Male

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Magellan Health Services of Arizona, Inc

  • Case Management Agency
  • Gilbert, AZ
  • NPI 1194965145
  NPD (past)
• Vo of Arizona, Inc.

  • Clinical Medical Laboratory
  • Glendale, AZ
  • NPI 1447458682
  NPD (past)
• Vo of Arizona, Inc.

  • Case Management Agency
  • Phoenix, AZ
  • NPI 1730139593
  NPD (past)

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1871762203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 N CENTRAL AVE",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122902",
            "telephone_number": "602-685-6000",
            "fax_number": "602-302-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8836 N 23RD AVE",
            "address_2": "B1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214185",
            "telephone_number": "602-944-9810",
            "fax_number": "602-216-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISHAM",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-29",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "12209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285751",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crimson Living Facility LLC
• Kelsey Cring, DPT
• Meryl Cripe, PT
• Robert Crippen, BCBA, LBA
• Haley Lynn Crise
• Tisha L Crisler
• Richard Crislip, LCSW
• Kaitlin Crisman, PT, DPT
• Vernon Wesley Crisp Jr., DO
• Cynthia A Criss, LPC,

• Psychiatry Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatry Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.