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CRYSTAL BASTIN MD LLC
NPI 1053539387
Family Medicine in South Charleston, WV

Active since April 23, 2007
4820 KENTUCKY ST, SOUTH CHARLESTON, WV 25309(304) 720-0390 Get Directions Write a Review

NPPES record last updated: November 12, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Crystal Bastin Md Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CRYSTAL BASTIN MD LLC (NPI 1053539387) is a healthcare organization registered as a family medicine in South Charleston, West Virginia and active in the NPI registry since April 2007. The organization lists Shannon G Davis, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1053539387
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCRYSTAL BASTIN MD LLC
Location Address4820 KENTUCKY STSouth Charleston, WV 25309-1310
Mailing Address4820 Kentucky StreetSouth Charleston, WV 25309-1364 · (304) 720-0390
Phone(304) 720-0390
Organization SubpartNo
Authorized OfficialShannon G DavisOffice Manager · (304) 720-0390
Enumeration DateApril 23, 2007
Last NPPES UpdateNovember 12, 2013
✔ NPI 1053539387 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in WV · 20368
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4820 KENTUCKY ST, South Charleston, WV 25309
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Other Identifiers 3

Medicaid1801865001WV
Medicare UPINH32607WV
Medicare ID-Type Unspecified9325831WV

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REBECCA J DONOHOE
Nurse Practitioner (Family)
4820 KENTUCKY ST
SOUTH CHARLESTON, WV 25309
Kanawha County (304) 720-0390
HERBERT J THOMAS MEMORIAL HOSPITAL ASSOCIATION
Family Medicine
4820 KENTUCKY ST
SOUTH CHARLESTON, WV 25309
Kanawha County (304) 720-0390
DR. CRYSTAL H BASTIN M.D.
Family Medicine
4820 KENTUCKY ST
SOUTH CHARLESTON, WV 25309
Kanawha County (304) 720-0390

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crystal Bastin MD LLC's NPI number?

The NPI number for Crystal Bastin MD LLC is 1053539387. It was assigned to this organization in the NPPES registry on April 23, 2007.

Where is Crystal Bastin MD LLC located?

Crystal Bastin MD LLC is located at 4820 Kentucky St, South Charleston, WV 25309. The listed phone number is (304) 720-0390.

What is Crystal Bastin MD LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Crystal Bastin MD LLC was last updated on November 12, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.