Individual provider Active NPI

Crystal Somerville

  • Professional Counselor
  • Rustburg, VA
National Provider Identifier
1972018190
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701007384 Issued in VA
Practice address
37 Village Hwy
Rustburg, VA 24588-4112
Phone
(434) 332-5159
NPI assigned
Dec 11, 2017
Last updated
Dec 11, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0701007384 VA Primary

Addresses

Primary practice location

37 Village Hwy
Rustburg, VA 24588-4112

Mailing address

3410 Old Forest Rd
Lynchburg, VA 24501-2915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231212002999 PA Practitioner - Mental Health Counselor 9335598630 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

1015 Chestnut St
Suite 1520
Philadelphia, PA 19107-4315
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0701007384VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Jan 1, 2024 Accepting new patients
St. Luke's Physician Group, Inc. CurrentSince Mar 30, 2024 Accepting new patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St Luke's Physician Group Inc CurrentSince Mar 30, 2024 Accepting new patients
Horizon Behavioral Health Past Accepting new patients
Horizon Behavioral Health PastSince Jul 11, 2017 Accepting new patients

Locations

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

1015 Chestnut St
Ste 1520
Philadelphia, PA 19107
Phone (215) 601-7379

5830 Ellsworth Ave
Ste 301
Pittsburgh, PA 15232
Phone (412) 208-6279

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1512950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512950400000",
    "number": "1972018190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 OLD FOREST RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 VILLAGE HWY",
            "city": "RUSTBURG",
            "state": "VA",
            "postal_code": "245884112",
            "telephone_number": "434-332-5159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOMERVILLE",
        "first_name": "CRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-11",
        "last_updated": "2017-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701007384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rustburg, VA

Sources for this page

Verify at the official NPI Registry.