Provider Demographics
NPI:1497890115
Name:CROUCH, JASON MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:CROUCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 MANVEL AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-3858
Mailing Address - Country:US
Mailing Address - Phone:405-258-9955
Mailing Address - Fax:405-258-9930
Practice Address - Street 1:806 MANVEL AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-3858
Practice Address - Country:US
Practice Address - Phone:405-258-9955
Practice Address - Fax:405-258-9930
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200116510 AOtherMEDICAID # FOR CROUCH FAMILY MEDICINE (CLINIC)
37D1067992OtherCLIA # FOR CROUCH FAMILY MEDICINE LAB (CLIA-WAIVED LAB)
9060050OtherAETNA PIN
1618242OtherCOVENTRY HEALTH CARE PROVIDER ID #
OK200116510AMedicaid
6147210001OtherDURABLE MEDICAL EQUIPMENT (DME) PTAN
P00465778OtherRAILROAD MEDICARE PT B PTAN
OK200116520AMedicaid
300522328OtherMEDICARE # FOR CROUCH FAMILY MEDICINE (CLINIC)
DG9878OtherRAILROAD MEDICARE PT B GROUP NUMBER
1609093228OtherNPI FOR CROUCH FAMILY MEDICINE PC (ORGANIZATION NPI)
243722101OtherMEDICARE # FOR JASON CROUCH, D.O.
1497890115OtherNPI FOR JASON CROUCH, D.O.
OK200116520 AOtherMEDICAID # FOR JASON CROUCH, D.O.
4474235OtherCIGNA HEALTHCARE PROVIDER #
9060050OtherAETNA PIN
243722101OtherMEDICARE # FOR JASON CROUCH, D.O.
37D1067992OtherCLIA # FOR CROUCH FAMILY MEDICINE LAB (CLIA-WAIVED LAB)
4474235OtherCIGNA HEALTHCARE PROVIDER #
300522328OtherMEDICARE # FOR CROUCH FAMILY MEDICINE (CLINIC)
P00465778Medicare PIN