Elisa Marie Crystal Wang, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

312716 Issued in NY

Practice address

201 E Green St
Ithaca, NY 14850-5635

Phone

(607) 274-6200

NPI assigned

Jun 23, 2014

Last updated

May 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Elisa Marie Crystal Former name

Medicare fee-for-service enrollment

Enrolled in IL, NY2 enrollments

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.

Enrollment records 2

Specialty

Psychiatry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tompkins CountyGroup PAC ID 0143210443, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ecrystal690714@direct.ochin.org

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.

• Tompkins County

  dba Tompkins County Mental Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ithaca, NY
  • NPI 1588686596
  Medicare reassignment Care Compare group NPD
• Lawndale Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1245289214
  Medicare reassignment NPD
• Lawndale Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1326215450
  NPD
• Lawndale Christian Health Center

  • Health Educator
  • Chicago, IL
  • NPI 1588537641
  NPD
• Lawndale Christian Health Center

  dba Lawndale Christian Health Center Pharmacy

  • Community/Retail Pharmacy
  • Chicago, IL
  • NPI 1679680235
  NPD

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1942615646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E GREEN ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505635",
            "telephone_number": "607-274-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E GREEN ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505635",
            "telephone_number": "607-274-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3860 W Ogden Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606232460",
            "country_code": "US",
            "telephone_number": "872-588-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "ELISA",
        "middle_name": "MARIE CRYSTAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-23",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036146202",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "312716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISA",
            "last_name": "CRYSTAL",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily M Walsh, LCAT, ATR
• Brett James Walters
• Amy Louise Walton, LCSW MSW
• Amanda Walts, LCSW
• Cody Matthew Wamsley
• Grace Wang
• Yuyan Wang, PH.D, L.AC.
• Brian Wansink, PHD
• Laura Katherine Ward, M.S.
• Lawrence Ward

• Psychiatry Physician in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.