Dr Jason Matthew Crisp, NP-C is a medicare enrolled "Nurse Practitioner - Family" in Ft Campbell, Kentucky. His current practice location is
650 Joel Dr, Ft Campbell, Kentucky. You can reach out to his office (for appointments etc.) via phone at
(270) 798-8388.
Dr Jason Matthew Crisp is licensed to practice in Kentucky (license number 1126653) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1598192858.
Provider's Profile
| Full Name | Dr Jason Matthew Crisp |
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| Gender | Male |
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| Speciality | Nurse Practitioner - Family |
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| Location | 650 Joel Dr, Ft Campbell, Kentucky |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1598192858
- Provider Enumeration Date: 10/02/2013
- Last Update Date: 10/04/2023
Medicare PECOS Information:
- PECOS PAC ID: 0042570046
- Enrollment ID: I20180213001564
Medical Identifiers
Medical identifiers for Dr Jason Matthew Crisp such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1598192858 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | 29942 (Tennessee) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 1126653 (Kentucky) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jason Matthew Crisp allows following entities to bill medicare on his behalf.
| Entity Name | Brock Medical, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1023379815
PECOS PAC ID: 9830354638
Enrollment ID: O20120628000567 |
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| Entity Name | Fast Pace Kentucky, Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1457716706
PECOS PAC ID: 0143525998
Enrollment ID: O20160216002913 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jason Matthew Crisp is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jason Matthew Crisp, NP-C
562 Justify Dr,
Hopkinsville, KY 42240-7914
Ph: (210) 725-5821 | Dr Jason Matthew Crisp, NP-C
650 Joel Dr,
Ft Campbell, KY 42223
Ph: (270) 798-8388 |
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