Individual provider Active NPI

Bryant A Boyack, DO

  • Emergency Medicine Physician
  • Mesa, AZ
National Provider Identifier
1902008956
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
005310 Issued in AZ
Practice address
6644 E Baywood Ave
Mesa, AZ 85206-1747
Phone
(480) 321-4200
NPI assigned
Jun 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 005310 AZ Primary

Addresses

Primary practice location

6644 E Baywood Ave
Mesa, AZ 85206-1747

Mailing address

3004 E Nora St
Mesa, AZ 85213-1619
Phone (623) 337-0968

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100507000351 AZ Practitioner - Emergency Medicine 1658409909 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Southwest, PC Emergency Medicine CurrentSince Dec 13, 2010 Accepting new patients
Tec Emergency Physicians of Arizona, LLC CurrentSince Sep 30, 2020 Accepting new patients
Quantum Healthcare Medical Associates of Arizona, PC Emergency Medicine CurrentSince Aug 13, 2012 Accepting new patients

Locations

1800 E Florence Blvd
Casa Grande, AZ 85122
Phone (520) 381-6285

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

1910 S Gilbert Rd
Mesa, AZ 85204
Phone (480) 410-6150

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

807 S Ponderosa St
Payson, AZ 85541
Phone (520) 474-3222

1419 W Hunt Hwy
San Tan Vly, AZ 85143
Phone (480) 245-4300

5125 S Rural Rd
Tempe, AZ 85282
Phone (480) 306-8780

Organizations & group practices 3

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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1902008956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3004 E NORA ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852131619",
            "telephone_number": "623-337-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6644 E BAYWOOD AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061747",
            "telephone_number": "480-321-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYACK",
        "first_name": "BRYANT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "005310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.