Brian McCormack, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

054959-1 Issued in NY

Practice address

2500 Nesconset Hwy BLDG 18a
Stony Brook, NY 11790-2563

Phone

(516) 313-6949

NPI assigned

Apr 15, 2009

Last updated

Jun 7, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 23, 2015 through Jun 23, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Advanced Endodontics of Long Island, P.C.

  • Endodontics
  • Stony Brook, NY
  • NPI 1598029779
  NPD (past)

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

{
    "created_epoch": "1239753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339027200000",
    "number": "1619110996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY BLDG 18A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902563",
            "telephone_number": "516-313-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY BLDG 18A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902563",
            "telephone_number": "516-313-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-15",
        "last_updated": "2012-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "054959-1",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesse T McCarthy, PA
• Kristen McCarthy, NP
• Deborah McCaw, NP
• Jessica McCloskey
• Matthew C McClure, D.O.
• Jessica Lynn McCurdy, PH.D.
• Karen K. McDonald, FNP
• Janeen McFarlane, REGISTERED NURSE
• Margaret Mary McGovern, MD, PHD
• Kelcy McIntyre

• Endodontics in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Endodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.