Kevin James Crockett

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10620174-1206 Issued in UT

Practice address

30 E Hunters HVN
Saratoga Springs, UT 84045-8169

Phone

(801) 400-9616

NPI assigned

Jan 3, 2018

Last updated

Jan 3, 2018By 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

Medicare fee-for-service enrollment

Enrolled in UT

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

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

• Emergency Physicians Integrated Care, LLC

  • Emergency Medicine Physician
  • Salt Lake City, UT
  • NPI 1578598199
  Medicare reassignment NPD

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514937600000",
    "number": "1932616695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E HUNTERS HVN",
            "city": "SARATOGA SPRINGS",
            "state": "UT",
            "postal_code": "840458169",
            "telephone_number": "801-400-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E HUNTERS HVN",
            "city": "SARATOGA SPRINGS",
            "state": "UT",
            "postal_code": "840458169",
            "telephone_number": "801-400-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "KEVIN",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10620174-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Costco Wholesale Corporation (Costco Optical #1383)
• Costco Wholesale Corporation (Costco Pharmacy #1383)
• Allyson Linzey Cowdell, M.S., CCC-SLP
• Kjerstin Cox
• Sydney Crandall
• Sage Crook
• Crossroads Family Medicine
• Mackenzie Cruz, PT, DPT
• Brooklyn Daines
• Ruth Daley

• Physician Assistant in Saratoga Springs, UT
• Providers in Saratoga Springs, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; 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.