Active NPI
Theodore W McCrary, PAC
- Physician Assistant
- Knoxville, TN
National Provider Identifier
1356334973
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Jul 20, 2020.
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 560
- Practice address
- 301 S Gallaher View Rd Ste 224
Knoxville, TN 37919-5361 - Phone
- (865) 951-2012
- Fax
- (865) 951-2575
- NPI assigned
- Aug 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 560 | TN | Primary |
Addresses
Primary practice location
301 S Gallaher View Rd Ste 224
Knoxville, TN 37919-5361
Mailing address
301 S Gallaher View Rd Ste 224
Knoxville, TN 37919-5361
Phone (865) 951-2012
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3666869 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 560 | TN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357603200000",
"number": "1356334973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 S GALLAHER VIEW RD STE 224",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379195361",
"telephone_number": "865-951-2012",
"fax_number": "865-951-2575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 S GALLAHER VIEW RD STE 224",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379195361",
"telephone_number": "865-951-2012",
"fax_number": "865-951-2575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCRARY",
"first_name": "THEODORE",
"middle_name": "W",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-30",
"last_updated": "2013-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "560",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3666869",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.