NPIMap

Individual provider Active NPI

Carlynn H Crevier, M.D.

  • Internal Medicine Physician
  • Mount Pleasant, WI
National Provider Identifier
1962504670
Registry record updated Oct 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
50335 Issued in WI
Practice address
4328 Old Green Bay Rd
Mount Pleasant, WI 53403-9489
Phone
(262) 687-7606
Fax
(262) 687-7615
NPI assigned
Sep 2, 2006
Last updated
Oct 1, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-115459 IL
Internal Medicine Physician 207R00000X 50335 WI Primary

Addresses

Primary practice location

4328 Old Green Bay Rd
Mount Pleasant, WI 53403-9489

Mailing address

4328 Old Green Bay Rd
Mount Pleasant, WI 53403-9489
Phone (262) 687-7606

Other names 1

  • Carlynn H. Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070724000313 WI Practitioner - Internal Medicine 8820095201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Wisconsin, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-115459ILMDInternal Medicine Physician
50335WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine CurrentSince Aug 13, 2007 Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

3807 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-8173

3821 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-8460

4328 Old Green Bay Rd
Mount Pleasant, WI 53403
Phone (262) 687-7606

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

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

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380585600000",
    "number": "1962504670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4328 OLD GREEN BAY RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039489",
            "telephone_number": "262-687-7606",
            "fax_number": "262-687-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4328 OLD GREEN BAY RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039489",
            "telephone_number": "262-687-7606",
            "fax_number": "262-687-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREVIER",
        "first_name": "CARLYNN",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2013-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-115459",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "50335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLYNN",
            "last_name": "SMITH",
            "middle_name": "H.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mount Pleasant, WI

Sources for this page

Verify at the official NPI Registry.