Individual provider Active NPI

Brian Wayne Davis, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Missoula, MT
National Provider Identifier
1205913506
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
18582 Issued in MT
Practice address
4625 Bordeaux Blvd
Missoula, MT 59808-8686
Phone
(859) 533-3471
NPI assigned
Nov 1, 2006
Last updated
Apr 28, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X LL29140 SC
Internal Medicine Physician 207R00000X 256390 NY
Internal Medicine Physician 207R00000X 18582 MT
Internal Medicine Physician 207R00000X MD2016-0024 NM
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 256390 NY
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 18582 MT Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X MD2016-0024 NM
Pulmonary Disease Physician 207RP1001X 256390 NY
Pulmonary Disease Physician 207RP1001X 18582 MT
Pulmonary Disease Physician 207RP1001X MD2016-0024 NM

Addresses

Primary practice location

4625 Bordeaux Blvd
Missoula, MT 59808-8686

Mailing address

4625 Bordeaux Blvd
Missoula, MT 59808-8686
Phone (859) 533-3471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210301002050 TN Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 0244488344 Reassigns benefits to 1 organization
I20221017001451 TX Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 0244488344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
University of Kentucky College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gulf Coast Intensivists, PLLCGroup PAC ID 2264896364, 39 clinicians

Practice addresses (Care Compare)

600 Elizabeth St
Corpus Christi, TX 78404-2235
Phone (361) 881-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18582MTMDInternal Medicine Physician
LL29140SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Intensivists, PLLC Critical Care Medicine CurrentSince Sep 1, 2023 Accepting new patients
University Health System Inc CurrentSince Feb 1, 2021 Accepting new patients
University Health System, Inc Internal Medicine Current Accepting new patients
University Health System, Inc Pulmonary Disease CurrentSince Feb 1, 2021 Accepting new patients
Christus Spohn Health System Corporation Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

1940 Alcoa Hwy
Ste E120
Knoxville, TN 37920
Phone (865) 305-8040

1940 Alcoa Hwy
Ste E210
Knoxville, TN 37920
Phone (865) 524-7471

9000 Executive Park Dr
Ste C200
Knoxville, TN 37923
Phone (865) 670-6142

600 Elizabeth St
Corpus Christi, TX 78404
Phone (361) 325-2511

Organizations & group practices 6

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1205913506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 BORDEAUX BLVD",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598088686",
            "telephone_number": "859-533-3471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 BORDEAUX BLVD",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598088686",
            "telephone_number": "859-533-3471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BRIAN",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL29140",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "256390",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "18582",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2016-0024",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "256390",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MT",
            "license": "18582",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NM",
            "license": "MD2016-0024",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "256390",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MT",
            "license": "18582",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NM",
            "license": "MD2016-0024",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.