MEDICARE: CRESCENT DIRECT PRIMARY CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1124979950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT DIRECT PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	23 DURANGO DR
Second Line	:
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-5120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 E HIGHWAY 114 STE 200
Second Line	:
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-5306
Country	:	US
Telephone Number	:	682-800-4727
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ELVIRA JASAREVIC
Credential	:	DO
Telephone Number	:	336-207-5677

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	03/04/2026

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