Active NPI
Cory Mackenzie Rush, D.M.D.
- Dentist
- Phoenix, AZ
National Provider Identifier
1194131557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9934
- Practice address
- 4350 E Ray Rd Ste 112
Phoenix, AZ 85044-4705 - Phone
- (480) 893-7674
- NPI assigned
- Jul 7, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30205 | TX | |
| Dentist | 122300000X | 9934 | AZ | Primary |
Addresses
Primary practice location
4350 E Ray Rd Ste 112
Phoenix, AZ 85044-4705
Mailing address
2553 E Linda LN
Gilbert, AZ 85234-1305
Phone (602) 300-1059
Other practice location 1
2672 Basswood Dr
Grand Prairie, TX 75052-4700
Phone (602) 300-1059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 10, 2016 through May 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9934 | AZ | MD | Dentist |
| 30205 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pecan Tree Dental | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Preferred Provider Organization
- Grand Prairie, TX
- NPI 1871909127
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1194131557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2553 E LINDA LN",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852341305",
"telephone_number": "602-300-1059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4350 E RAY RD STE 112",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850444705",
"telephone_number": "480-893-7674"
}
],
"practiceLocations": [
{
"address_1": "2672 Basswood Dr",
"address_purpose": "LOCATION",
"city": "Grand Prairie",
"state": "TX",
"postal_code": "750524700",
"country_code": "US",
"telephone_number": "602-300-1059",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RUSH",
"first_name": "CORY",
"middle_name": "MACKENZIE",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-07",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "30205",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "9934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.