Individual provider Active NPI

Crystal Lynn O'Connell, NP

  • Nurse Practitioner
  • Fall River, MA
National Provider Identifier
1881822831
Registry record updated Sep 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN2260144 Issued in MA
Practice address
300 Hanover St
Fall River, MA 02720-5444
Phone
(508) 973-8611
Fax
(508) 973-8615
NPI assigned
Jun 29, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN2260144 MA Primary

Addresses

Primary practice location

300 Hanover St
Fall River, MA 02720-5444

Mailing address

200 Mill Rd
Fairhaven, MA 02719-5252
Phone (508) 973-2000

Other identifiers 1

IdentifierTypeStateIssuer
110134143AMedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address coconnell15504@direct.southcoast.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180806002255 MA Practitioner - Nurse Practitioner 0547518615 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

100 Rosebrook Way
Wareham, MA 02571-1138
Phone (508) 273-4900

101 Page St
New Bedford, MA 02740-3464
Phone (508) 973-5919

363 Highland Ave
Fall River, MA 02720-3703
Phone (508) 973-5919

43 High St
Wareham, MA 02571-2097
Phone (508) 973-5919

534 Prospect St
Fall River, MA 02720-5281
Phone (508) 973-7766

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN2260144MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. CurrentSince Jun 24, 2018 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Jun 24, 2018 Accepting new patients

Locations

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

300 Hanover St
Fall River, MA 02720
Phone (508) 677-0700

363 Highland Ave
Fall River, MA 02720
Phone (508) 679-7052

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

500 Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 973-2216

43 High St
Wareham, MA 02571
Phone (508) 273-4200

Interoperability endpoints

  • Direct secure messaging: coconnell15504@direct.southcoast.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725753600000",
    "number": "1881822831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HANOVER ST",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027205444",
            "telephone_number": "508-973-8611",
            "fax_number": "508-973-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNELL",
        "first_name": "CRYSTAL",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-29",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2260144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110134143A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "coconnell15504@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "101 Page St",
            "city": "New Bedford",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027403464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fall River, MA

Sources for this page

Verify at the official NPI Registry.