MEDICARE: JAMES R CRANDELL MD

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	207RC0000X	Cardiovascular Disease Physician	35059930C	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	9273172	OTHER	GROUP MEDICARE
6	CA4511	OTHER	RR MEDICARE GROUP
8	110213802	OTHER	RR MEDICARE INDIVIDUAL
9	3610861	OTHER	GROUP ASC MEDICARE
14	CA4511	OTHER	GROUP RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	D368301	OTHER	GROUP IND DIAGNOTICS MED
3	109934	OTHER	KAISER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2448496	OTHER	AETNA
7	10790137	OTHER	CAQH
10	L59930	OTHER	SUMMACARE APEX
11	341783789055	OTHER	CARESOURCE
12	000000188027	OTHER	ANTHEM
13	1780634279	OTHER	GROUP NPI
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	2502257	OTHER	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1396711610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R CRANDELL MD

Provider Business Mailing Address
First Line	:	PO BOX 378
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011
Country	:	US
Telephone Number	:	440-695-4000
Fax Number	:	440-695-4669

Provider Business Practice Location Address
First Line	:	1730 W 25TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3108
Country	:	US
Telephone Number	:	216-363-2331
Fax Number	:	216-696-2888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	02/05/2026

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Directions to “ JAMES R CRANDELL MD” Practice Location

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