Charlene A Crichton, MD
Individual provider Active NPI Neonatal-Perinatal Medicine Physician · Boise, ID
NPI 1922037852 · NPPES record last updated Mar 14, 2011
Key facts
- NPI
- 1922037852
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neonatal-Perinatal Medicine Physician 2080N0001X
- License
- M9296 (ID)
- Practice address
- 190 E Bannock St
Boise, ID 83712-6241 - Phone
- (208) 381-2222
- NPI assigned
- Jul 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050818000089 | ID | Practitioner - Pediatric Medicine |
6002718038 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M9296 | ID | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Neonatal-Perinatal Medicine | Current |
Accepting new patients |
Locations
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
305 E Jefferson St
Boise, ID 83712
Phone (208) 345-0715
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
Interoperability endpoints
- ccrichton30412@direct.slhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | M9296 | ID | Yes |
Addresses
Primary practice location
190 E Bannock St
Boise, ID 83712-6241
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222
Other providers in Boise, ID
- Russell D Crawford
- Danielle Cremer
- Crescent Creek Therapy, LLC
- Creswell Counseling Center LLC
- Judith Anne Crews
- Rolf O Crichton
- Carey Dawn Crill
- Kristin Cripps
- Matthew R Crispo
- John D Crites
All providers in Boise, ID · Neonatal-Perinatal Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.