John Tucker McCormick, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-747 Issued in AR

Practice address

4375 N Vantage Dr Ste 305
Fayetteville, AR 72703-4984

Phone

(479) 443-5100

Fax

(479) 443-5117

NPI assigned

Nov 7, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in AR, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ozark Dermatology ClinicGroup PAC ID 5799712147, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Ozark Dermatology Clinic

  • Specialist
  • Fayetteville, AR
  • NPI 1134207483
  Medicare reassignment Care Compare group
• Last Frontier Healthcare District

  • Critical Access Hospital
  • Alturas, CA
  • NPI 1487669032
  Medicare reassignment NPD
• Ameripath SC Inc

  • Clinical Medical Laboratory
  • Mount Pleasant, SC
  • NPI 1528030368
  NPD (past)

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1477066926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4375 N VANTAGE DR STE 305",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034984",
            "telephone_number": "479-443-5100",
            "fax_number": "479-443-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4375 N VANTAGE DR STE 305",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034984",
            "telephone_number": "479-443-5100",
            "fax_number": "479-443-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "JOHN",
        "middle_name": "TUCKER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-07",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "4941",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA061232",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PA-747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda McClure
• Travis Knox McClure, M.D.
• Alexis N. McCollum, M.D.
• Gail S McConnell, MS CCC SLP
• Michelle Faith McConnell, AGACNP-BC
• Jon Garrett McCowan, M.D.
• Allyson McCoy, PLMSW
• Desma D McCoy, MHPP
• Sara McCoy, DPM
• Michael L McCracken, DDS

• Medical Physician Assistant in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Medical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.