Active NPI
Brian J. McGourty, O.D.
- Optometrist
- Nampa, ID
National Provider Identifier
1811091309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0-592
- Practice address
- 310 2ND St S
Nampa, ID 83651-3765 - Phone
- (208) 467-1361
- Fax
- (208) 467-9008
- NPI assigned
- Sep 12, 2006
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0-592 | ID | Primary |
Addresses
Primary practice location
310 2ND St S
Nampa, ID 83651-3765
Mailing address
310 2ND St S
Nampa, ID 83651-3765
Phone (208) 467-1361
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002622300 | Medicaid | ID | |
| 000010015424 | Other | ID | REGENCE BLUE SHIELD |
| E00820496865 | Other | ID | AETNA |
| 82049686583651A001 | Other | ID | TRICARE |
| V9063 | Other | ID | BLUE CROSS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0-592 | ID | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hollingshead Eye Center, PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277683200000",
"number": "1811091309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 2ND ST S",
"city": "NAMPA",
"state": "ID",
"postal_code": "836513765",
"telephone_number": "208-467-1361",
"fax_number": "208-467-9008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 2ND ST S",
"city": "NAMPA",
"state": "ID",
"postal_code": "836513765",
"telephone_number": "208-467-1361",
"fax_number": "208-467-9008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGOURTY",
"first_name": "BRIAN",
"middle_name": "J.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2010-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ID",
"license": "0-592",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002622300",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010015424",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "E00820496865",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "82049686583651A001",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "V9063",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.