Bryan Anthony Davis, PA
Individual provider Active NPI Physician Assistant · Vienna, MO
NPI 1316928682 · NPPES record last updated Jul 14, 2026
Key facts
- NPI
- 1316928682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2006006970 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pcrmc Medical Group Inc
Practice addresses (Care Compare)
174 Ballpark Rd
Vienna, MO 65582-8043
Phone (573) 422-3177
Hospital & facility affiliations
- Elara Caring
- Phelps County Regional Medical Center
- University of Missouri Health Care
- SSM Health St. Mary'S Hospital - Jefferson City
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090513000113 | MO | Practitioner - Physician Assistant | 9739237496 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1300 | OK | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phelps County Regional Medical Center | Current |
Accepting new patients |
Locations
1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1300 | OK | |
| Physician Assistant | 363A00000X | 2006006970 | MO | Yes |
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
Other providers in Vienna, MO
- Americare at Victorian Manor of Vienna, LLC
- Barnhart Sleep Solutions LLC
- John Francis Barnhart
- Joseph William Barnhart
- Jennifer Renae Berhorst
- Cynthia Louise Harris
- Audrey Holtmeyer
- John F Barnhart, DDS, PC
- Joseph W Barnhart, DDS
- Maries Osage Ambulance District
All providers in Vienna, MO · Physician Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.