Michael J McCusker, P. A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA01335 Issued in OR

Practice address

530 NW 27TH St
Corvallis, OR 97330-5223

Phone

(541) 766-6611

Fax

(541) 766-6186

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Valley Clinics

  • Primary Care Clinic/Center
  • Corvallis, OR
  • NPI 1457842833
  Medicare reassignment
• Corvallis Internal Medicine, PC

  • Internal Medicine Physician
  • Corvallis, OR
  • NPI 1710172622
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1013096684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "981 NW SPRUCE AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973302111",
            "telephone_number": "541-758-0766",
            "fax_number": "541-753-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NW 27TH ST",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973305223",
            "telephone_number": "541-766-6611",
            "fax_number": "541-766-6186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCUSKER",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "P. A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA01335",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MA052623",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500634427",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON MEDICAL BOARD",
            "identifier": "PA01335",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Laurence McCrum
• Minda McCullough-Yray, MS, ATC
• Peggy Lisa McCullum, CNM
• Kyle Nelson McCune
• Madeline McCurdy, BS
• Jennifer Larisa McDermond, QMHA
• Jason Paul McDougal
• Kindra Marie McDougall, DPT
• Megan McElfresh, MD
• Christopher McFarland

• Medical Physician Assistant in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.