Active NPI
Kristina Marie Crespo, PA-C
- Physician Assistant
- South Bend, IN
National Provider Identifier
1962123075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1245 E Ireland Rd
South Bend, IN 46614-3448 - Phone
- (574) 312-7022
- NPI assigned
- Sep 7, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1245 E Ireland Rd
South Bend, IN 46614-3448
Mailing address
88 E Monaville Rd
Lake Villa, IL 60046-9155
Phone (219) 433-7763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
405 W Golf Rd
Schaumburg, IL 60195-3501
Phone (224) 215-0011
4211 N Cicero Ave
Chicago, IL 60641-1651
Phone (773) 794-1000
7425 Barrington Rd
Hanover Park, IL 60133-2241
Phone (630) 823-0392
8630 W Golf Rd
Niles, IL 60714-5600
Phone (847) 299-0009
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Urgent Care Clinic/Center
- Chicago, IL
- NPI 1205814118
-
- Urgent Care Clinic/Center
- Mishawaka, IN
- NPI 1942546890
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1962123075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "88 E MONAVILLE RD",
"city": "LAKE VILLA",
"state": "IL",
"postal_code": "600469155",
"telephone_number": "219-433-7763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 E IRELAND RD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466143448",
"telephone_number": "574-312-7022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRESPO",
"first_name": "KRISTINA",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-07",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.