NPIMap

Individual provider Active NPI

Bryan Anthony Davis, PA

  • Physician Assistant
  • Vienna, MO
National Provider Identifier
1316928682
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2006006970 Issued in MO
Practice address
606 Highway 63 S Ste a
Vienna, MO 65582-8101
Phone
(573) 422-3636
Fax
(573) 202-2433
NPI assigned
Nov 14, 2005
Last updated
Jul 14, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1300 OK
Physician Assistant 363A00000X 2006006970 MO Primary

Addresses

Primary practice location

606 Highway 63 S Ste a
Vienna, MO 65582-8101

Mailing address

606 Highway 63 S
Vienna, MO 65582-8101
Phone (573) 422-3636

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090513000113 MO Practitioner - Physician Assistant 9739237496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians

Practice addresses (Care Compare)

174 Ballpark Rd
Vienna, MO 65582-8043
Phone (573) 422-3177

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1300OKMDClinical Psychologist
2006006970MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Phelps County Regional Medical Center CurrentSince Feb 16, 2009 Accepting new patients

Locations

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

Organizations & group practices 2

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 7

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": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1316928682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 HIGHWAY 63 S",
            "city": "VIENNA",
            "state": "MO",
            "postal_code": "655828101",
            "telephone_number": "573-422-3636",
            "fax_number": "573-202-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 HIGHWAY 63 S STE A",
            "city": "VIENNA",
            "state": "MO",
            "postal_code": "655828101",
            "telephone_number": "573-422-3636",
            "fax_number": "573-202-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BRYAN",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1300",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2006006970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vienna, MO

Sources for this page

Verify at the official NPI Registry.