Kelly Joe Krizan, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD00024212 Issued in WA

Practice address

3417 Ensign Rd NE
Olympia, WA 98506-5064

Phone

(360) 493-4600

Fax

(360) 493-4603

NPI assigned

Apr 5, 2006

Last updated

Oct 15, 2010By the provider in NPPES

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 4

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

• Kelly J Krizan

  dba Crusader Diagnostic Imaging

  • Diagnostic Radiology Physician
  • Walla Walla, WA
  • NPI 1568493468
  NPD (past) Authorized official

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1881656841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3417 ENSIGN RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065064",
            "telephone_number": "360-493-4600",
            "fax_number": "360-493-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 ENSIGN RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065064",
            "telephone_number": "360-493-4600",
            "fax_number": "360-493-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRIZAN",
        "first_name": "KELLY",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00024212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8450025",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207097",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "5995KR",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807397800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Kreger, DO
• Natalie I Kreinbrink Kather, MD
• Bethany Kreitl
• Christina Lynn Kressin, RN, IBCLC
• Marie Krig, M.D.
• Matthew Michael Krnich
• Emilie Kromer, M.A., L.M.H.C.
• Sai Charan Krovi, PHARM.D
• Richard Tang Krug, M.D.
• James F Kruidenier, MD

• Diagnostic Radiology Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Diagnostic Radiology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; 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.