Stephen Herrick Cruikshank, M.D.,MBA

Primary specialty

SpecialistTaxonomy code 174400000X

License

35.066030 Issued in OH

Practice address

122 Gateway Blvd Ste 200
Mooresville, NC 28117-5544

Phone

(704) 658-0286

Fax

(704) 660-0196

NPI assigned

May 7, 2013

Last updated

Feb 14, 2017By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 5, 2016 through Jan 5, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1912342676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 GATEWAY BLVD STE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175544",
            "telephone_number": "704-658-0286",
            "fax_number": "704-660-0196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 GATEWAY BLVD STE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175544",
            "telephone_number": "704-658-0286",
            "fax_number": "704-660-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUIKSHANK",
        "first_name": "STEPHEN",
        "middle_name": "HERRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.,MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-07",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OH",
            "license": "35.066030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.