Individual provider Active NPI

Brian Fountain McCrary, D.O.

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Phoenix, AZ
National Provider Identifier
1972597490
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
License
2269 Issued in AZ
Practice address
1012 E Willetta St
Phoenix, AZ 85006-2749
Phone
(602) 839-6040
NPI assigned
Sep 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Aerospace Medicine Physician 2083A0100X K4950 TX
Aerospace Medicine Physician 2083A0100X 4328 SD
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X 2191 IA
Occupational Medicine Physician 2083X0100X 2269 AZ
Occupational Medicine Physician 2083X0100X 29397 CO
Occupational Medicine Physician 2083X0100X A-884-89 NM
Occupational Medicine Physician 2083X0100X 836 NV
Occupational Medicine Physician 2083X0100X 6289 WY
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X 2269 AZ Primary
Aerospace Medicine Physician 2083A0100X 2269 AZ

Addresses

Primary practice location

1012 E Willetta St
Phoenix, AZ 85006-2749

Mailing address

PO Box 11773
Chandler, AZ 85248-0013
Phone (480) 907-7707

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
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2269AZMDSpecialist
4328SDMDAerospace Medicine Physician
29397COMDOccupational Medicine Physician
A-884-89NMMDOccupational Medicine Physician
836NVMDOccupational Medicine Physician
6289WYMDOccupational Medicine Physician
2191IAMDMedical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1972597490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11773",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852480013",
            "telephone_number": "480-907-7707",
            "fax_number": "480-907-7097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 E WILLETTA ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062749",
            "telephone_number": "602-839-6040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCRARY",
        "first_name": "BRIAN",
        "middle_name": "FOUNTAIN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "TX",
            "license": "K4950",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "SD",
            "license": "4328",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "IA",
            "license": "2191",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "AZ",
            "license": "2269",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "CO",
            "license": "29397",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NM",
            "license": "A-884-89",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NV",
            "license": "836",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "WY",
            "license": "6289",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "AZ",
            "license": "2269",
            "primary": true
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "AZ",
            "license": "2269",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.