Alexandra L Bourcy-Crandell, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00673 Issued in MS

Practice address

1503 Highway 45 N
Columbus, MS 39705-2113

Phone

(662) 328-9623

NPI assigned

Oct 27, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Golden Triangle Urgent Care LLC

  • Rural Health Clinic/Center
  • Starkville, MS
  • NPI 1346592045
  Medicare reassignment
• Golden Triangle Urgent Care LLC

  • Rural Health Clinic/Center
  • West Point, MS
  • NPI 1104559806

  Multi-Specialty

  NPD
• Carbon Health Primary Care of California PC

  • Multi-Specialty Clinic/Center
  • Berkeley, CA
  • NPI 1972057990
  NPD (past)
• Health and Life Organization, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1427715515

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1540598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1902373095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 FRIAR TUCK CIR",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397053012",
            "telephone_number": "585-698-0967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 HIGHWAY 45 N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052113",
            "telephone_number": "662-328-9623"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7275 E Southgate Dr Ste 204-206",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "95823",
            "country_code": "US",
            "telephone_number": "916-428-3788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4112 E Commerce Way",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958349680",
            "country_code": "US",
            "telephone_number": "916-447-6337",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8 Parham Dr",
            "address_purpose": "LOCATION",
            "city": "Penfield",
            "state": "NY",
            "postal_code": "145262913",
            "country_code": "US",
            "telephone_number": "585-698-0967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURCY-CRANDELL",
        "first_name": "ALEXANDRA",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-27",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA56628",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA56628",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA56628",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MS",
            "license": "PA00673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS MEDICAL BOARD",
            "identifier": "PA00673",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CALIFORNIA DCA",
            "identifier": "PA56628",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William C Bonner, RPH
• Amber Massey Borden, MD
• Robert C. Borden, M.D.
• John Covington Boswell, M.D.
• Paul R Bouchillon, PT
• Brittany Lee Bowen, FNP-BC
• Jazmann Bowen
• Karissa Wright Boyd, DO
• Kenneth Brian Boyd, D.O.
• Edward Clarke Bozeman Jr., D.M.D.

• Medical Physician Assistant in Columbus, MS
• Providers in Columbus, MS by specialty
• Medical Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.