Keirsun Crockett, MD - Medicare Diagnostic Radiology in Marietta, GA

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Keirsun Crockett, MD is a medicare enrolled "Radiology - Diagnostic Radiology" physician in Marietta, Georgia. He went to University Of Florida College Of Medicine and graduated in 2011 and has 13 years of diverse experience with area of expertise as Diagnostic Radiology. He is a member of the group practice Pro Radiology, Llc, M And B Imaging, Pc, Synergy Radiology Llc, Quantum Radiology Pc and his current practice location is 790 Church St Ne, Marietta, Georgia. You can reach out to his office (for appointments etc.) via phone at (678) 239-0420.

Keirsun Crockett is licensed to practice in Georgia (license number 077719) and he also participates in the medicare program. He may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1750678967.

Contact Information

Keirsun Crockett, MD
790 Church St Ne,
Marietta, GA 30060-7282
(678) 239-0420
Not Available

Map and Direction




Physician's Profile

Full NameKeirsun Crockett
GenderMale
SpecialityDiagnostic Radiology
Experience13 Years
Location790 Church St Ne, Marietta, Georgia
Accepts Medicare AssignmentsMay be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Keirsun Crockett attended and graduated from University Of Florida College Of Medicine in 2011
  NPI Data:
  • NPI Number: 1750678967
  • Provider Enumeration Date: 07/08/2011
  • Last Update Date: 02/21/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 2062715261
  • Enrollment ID: I20170817002445

Medical Identifiers

Medical identifiers for Keirsun Crockett such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1750678967NPI-NPPES
0116023629OtherVAVIRGINIA BOARD OF MEDICINE

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2085N0700XRadiology - Neuroradiology 077719 (Georgia)Secondary
390200000XStudent In An Organized Health Care Education/training Program 0116023629 (Virginia)Secondary
2085R0202XRadiology - Diagnostic Radiology 077719 (Georgia)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Wellstar Kennestone HospitalMarietta, GAHospital
Wellstar Cobb HospitalAustell, GAHospital
Wellstar Paulding HospitalHiram, GAHospital
Wellstar North Fulton HospitalRoswell, GAHospital
Wellstar Douglas HospitalDouglasville, GAHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Pro Radiology, Llc105269643269
M And B Imaging, Pc155762378259
Synergy Radiology Llc266872774469
Quantum Radiology Pc438554323094

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Keirsun Crockett allows following entities to bill medicare on his behalf.
Entity NameQuantum Radiology Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1366495988
PECOS PAC ID: 4385543230
Enrollment ID: O20040108000728
Entity NamePro Radiology, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1164966461
PECOS PAC ID: 1052696432
Enrollment ID: O20170327002470
Entity NameM & B Imaging, Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1932624723
PECOS PAC ID: 1557623782
Enrollment ID: O20180327002648
Entity NameSynergy Radiology Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1558886341
PECOS PAC ID: 2668727744
Enrollment ID: O20180613001114

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Keirsun Crockett is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Keirsun Crockett, MD
Po Box 3157,
Indianapolis, IN 46206-3157

Ph: (770) 405-2976		Keirsun Crockett, MD
790 Church St Ne,
Marietta, GA 30060-7282

Ph: (678) 239-0420

Reviews and Comments


Radiology Doctors in Marietta, GA

Dr. Chris Chan Moo Sung,
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Dr. Thomas Patrick Murphy, M.D.
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Nancy Chioma Okechukwu, M.D.
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James E Robertson, MD
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Thomas W Hinz, MD
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Dr. Joseph H Moyers, MD
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Practice Location: 790 Church St Ne, Ste 400, Marietta, GA 30060
Phone: 770-952-8899    
Dr. Elaine Grace Khatod, M.D.
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Practice Location: 790 Church St Ne Ste 400, Marietta, GA 30060
Phone: 770-405-2976    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.