NPIMap

Organization Active NPI

Crystal Run Healthcare Physicians LLP

  • General Practice Physician
  • Middletown, NY
National Provider Identifier
1952376410
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CRYSTAL RUN HEALTHCARE PHYSICIANS LLP
Practice address
155 Crystal Run Rd
Middletown, NY 10941-4028
Phone
(845) 703-6999
Fax
(845) 703-6297
NPI assigned
Feb 20, 2006
Last updated
Oct 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Gregory A Spencer, MDNPI 1194725168
Title
Chief Medical Officer
Phone
(845) 703-6999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X NY
Emergency Medicine Physician 207P00000X NY
Family Medicine Physician 207Q00000X NY
Internal Medicine Physician 207R00000X NY
Cardiovascular Disease Physician 207RC0000X NY
Clinical Cardiac Electrophysiology Physician 207RC0001X NY
Critical Care Medicine (Internal Medicine) Physician 207RC0200X NY
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NY
Gastroenterology Physician 207RG0100X NY
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NY
Hematology & Oncology Physician 207RH0003X NY
Interventional Cardiology Physician 207RI0011X NY
Infectious Disease Physician 207RI0200X NY
Magnetic Resonance Imaging (MRI) Internal Medicine Physician 207RM1200X NY
General Practice Physician 208D00000X NY Primary

Addresses

Primary practice location

155 Crystal Run Rd
Middletown, NY 10941-4028

Mailing address

155 Crystal Run Rd
Middletown, NY 10941-4028
Phone (845) 703-6999

Other identifiers 1

IdentifierTypeStateIssuer
02409709MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address healthcarellp.crystalrun.p1@direct.crystalrun.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040227000791 NY Part B Supplier - Clinic/Group Practice 6901792696 Receives reassigned benefits from 467 practitioners
5 other NPIs on this enrollment
Practice locations: Monroe, NY; West Nyack, NY; Warwick, NY; Rock Hill, NY; Newburgh, NY; Middletown, NY; Goshen, NY
O20141006001394 NJ Part B Supplier - Clinic/Group Practice 6901792696 Receives reassigned benefits from 2 practitioners
Practice locations: Englewood, NJ

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

300 Crystal Run Rd
Middletown, NY 10941
Phone (845) 692-6999

75 Ronald Reagan Blvd
Warwick, NY 10990
Phone (845) 794-6999

Practitioners & affiliated clinicians

Practitioners 468

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 468

NPI Registry JSON

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1952376410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CRYSTAL RUN RD",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414028",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 CRYSTAL RUN RD",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414028",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL RUN HEALTHCARE PHYSICIANS LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-20",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "845-703-6999",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RM1200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Magnetic Resonance Imaging (MRI)",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02409709",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "healthcarellp.crystalrun.p1@direct.crystalrun.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "155 Crystal Run Rd",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109414028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.