CRESTUS WILLIAM ROSER – Physician Assistant, NPI 1639810641

CRESTUS WILLIAM ROSER is a healthcare provider. based in Savannah, Tennessee. specializing in PHYSICIAN ASSISTANT. They hold a License No. 6112 (TN). The NPI Number for CRESTUS WILLIAM ROSER is 1639810641

Main info

Male
Sole Proprietor
4 Years Of Experience
Accepts Medicare Assignment
Name
CRESTUS WILLIAM ROSER
NPI
1639810641
Phone
(731) 607-5157
Address
760 AIRWAYS BLVD
Enumeration Date
5 April 2022
Last Update Date
30 September 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7319268000
Graduation Year
2022 (4 years ago)
PAC ID
6901333012
Group Practice PAC ID
3072412592
Professional Enrollment ID
I20241231000481
Address ID
TN383721904SA935XXRDXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience37
Completeness75
Years active:4State licenses:1Digital endpointsOther names

3,134 PHYSICIAN ASSISTANT in TN

Provider Addresses for CRESTUS WILLIAM ROSER

  • 760 AIRWAYS BLVD

    SAVANNAH, TN 383723274

    Phone: (731) 607-5157

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-12-31

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241231000481IPhysician AssistantTNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 38372)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3072412592View full group profile
NameSpecialtyState
-NC
Emergency MedicineMI
Internal MedicineNC
-VA
Emergency MedicineVA
Nurse PractitionerGA
Emergency MedicineNC
-TN
Emergency MedicineNC
Emergency MedicineCA

Reviews

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Frequently asked questions

Can I cross-check CRESTUS WILLIAM ROSER using NPI 1639810641?
NPI 1639810641 belongs to CRESTUS WILLIAM ROSER; compare other details if you need extra assurance.
Is CRESTUS WILLIAM ROSER still an active registrant?
CRESTUS WILLIAM ROSER carries an active NPI according to the public dataset.
What kind of doctor is CRESTUS WILLIAM ROSER?
CRESTUS WILLIAM ROSER is associated with Physician Assistant in the directory — Clinical services aligned with this taxonomy classification.
Where in Tennessee is CRESTUS WILLIAM ROSER registered?
Use Savannah, Tennessee as the headline location for CRESTUS WILLIAM ROSER here.
When was this NPI issued?
Enumeration for CRESTUS WILLIAM ROSER is noted as April 5, 2022 where the registry provides it.

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