Douglas Gordon McCarty I, PHYSICAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11412 Issued in CA

Practice address

12980 Frederick St Ste I
Moreno Valley, CA 92553-5263

Phone

(951) 924-3244

Fax

(951) 243-6976

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Doug Gordon McCarty I Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

State licenses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043315880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1958",
            "address_2": "32382 PINE MANOR LANE",
            "city": "RUNNING SPRINGS",
            "state": "CA",
            "postal_code": "923821958",
            "telephone_number": "909-800-1121",
            "fax_number": "909-867-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12980 FREDERICK ST STE I",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535263",
            "telephone_number": "951-924-3244",
            "fax_number": "951-243-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCARTY",
        "first_name": "DOUGLAS",
        "middle_name": "GORDON",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "PHYSICAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOUG",
            "last_name": "MCCARTY",
            "middle_name": "GORDON",
            "prefix": "MR.",
            "suffix": "I",
            "credential": "PHYSICIAN ASSISTANT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joshea Mayes
• Marla Joy Maynard, MFT
• Fatou Samb Mbengue, LVN
• Alexandra McBride
• Sean Johnston McCarthy, MD
• Lisa Marie McClain, RCP RRT RRT SDS
• Meghan McConaghy
• Jared Matthew McConnell
• Ronald Jeffrey McCowan, M.D.
• Sheatrice McCullough

• Physician Assistant in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.