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CRYSTAL WELLNESS CENTER INC
NPI 1124583349
Nurse Practitioner in San Antonio, TX

Active since February 01, 2019
6609 BLANCO RD STE 335, SAN ANTONIO, TX 78216(210) 455-1779(210) 802-4698 Get Directions Write a Review

NPPES record last updated: August 19, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 19, 2024, Jul 31, 2024, Jun 5, 2020 and 1 more (4 updates tracked since 2019).

About Crystal Wellness Center Inc NPPES

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

CRYSTAL WELLNESS CENTER INC (NPI 1124583349) is a healthcare organization registered as a nurse practitioner in San Antonio, Texas and active in the NPI registry since February 2019. The organization maintains a secondary practice location in San Antonio and lists Lawrence Mack, Owner, as its authorized official.

NPPES Registry Identity

NPI1124583349
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameCRYSTAL WELLNESS CENTER INC
Location Address6609 BLANCO RD STE 335San Antonio, TX 78216-4504
Mailing Address116 Gallery Cir Ste 201San Antonio, TX 78258-3341 · (210) 802-4695 · Fax (210) 802-4698
Phone(210) 455-1779
Fax(210) 802-4698
Organization SubpartNo
Authorized OfficialLawrence MackOwner · (210) 802-4695
Enumeration DateFebruary 1, 2019
Last NPPES UpdateAugust 19, 20244 updates tracked since enumeration
NPPES CertifiedAugust 19, 2024
✔ NPI 1124583349 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedDietitian, RegisteredTaxonomy 133V00000X
6609 BLANCO RD STE 335, San Antonio, TX 78216
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Secondary Practice Location 1

Location 1116 Gallery Cir Ste 201San Antonio, TX 78258-3341 · Phone (210) 802-4695 · Fax (210) 802-4698

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Crystal Wellness Center Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Crystal Wellness Center Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Violet Dakora, NURSE PRACTITIONER
Nurse Practitioner
NPI 1831557982
6609 BLANCO RD STE 365
San Antonio, TX 78216
(210) 802-4695
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Wellness Center Inc's NPI number?

The NPI number for Crystal Wellness Center Inc is 1124583349. It was assigned to this organization in the NPPES registry on February 1, 2019.

Where is Crystal Wellness Center Inc located?

Crystal Wellness Center Inc is located at 6609 Blanco Rd Ste 335, San Antonio, TX 78216. The listed phone number is (210) 455-1779.

What is Crystal Wellness Center Inc's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Crystal Wellness Center Inc enrolled in Medicare?

Yes. Crystal Wellness Center Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Crystal Wellness Center Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Crystal Wellness Center Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Crystal Wellness Center Inc accept?

Health plans from Blue Cross and Blue Shield of Texas list Crystal Wellness Center Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Crystal Wellness Center Inc was last updated on August 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.