OrganizationActive
Crestview Hospital Corporation
NPI 1629026133 · Family Medicine Physician · Crestview, FL
Provider details
- NPI number
- 1629026133
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jennifer Jackson, Sr Dir Onboarding & Prov Enrollment(615) 465-3334
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Rural Health Clinic/Center261QR1300X
Ambulatory Health Care Facilities
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
127c E. Redstone Ave
Crestview, FL 32539-5356
Phone: (850) 423-0061
Street-level locationGet directions
Mailing address
330 Franklin Rd # 135a-316
Brentwood, TN 37027-3280
Other names (DBA / former)
- Doing business as
- Gateway Medical Clinic
- Doing business as
- Gateway Medical Clinic
Registry dates
- Enumerated
- 2006-05-05
- Last updated
- 2022-03-18
- Certified
- 2022-02-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.