Active NPI
Julie McCormack
- Psychiatry Physician
- Fairborn, OH
National Provider Identifier
1174104129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 57.251765
- Practice address
- 2555 University Dr
Fairborn, OH 45324-6255 - Phone
- (937) 775-7792
- NPI assigned
- Apr 20, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 57.251765 | OH | Primary |
Addresses
Primary practice location
2555 University Dr
Fairborn, OH 45324-6255
Mailing address
2555 University Dr
Fairborn, OH 45324-6255
Phone (937) 775-7792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210827002824 | OH | Order and Referring Only - Psychiatry | 2466857461 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688601600000",
"number": "1174104129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2555 UNIVERSITY DR",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453246255",
"telephone_number": "937-775-7792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2555 UNIVERSITY DR",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453246255",
"telephone_number": "937-775-7792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMACK",
"first_name": "JULIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-20",
"last_updated": "2023-07-06",
"certification_date": "2023-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OH",
"license": "57.251765",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.