Active NPI
Brian Fountain McCrary, D.O.
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
- Phoenix, AZ
National Provider Identifier
1972597490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
- License
- 2269
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 2269 | AZ | MD | Specialist |
| 4328 | SD | MD | Aerospace Medicine Physician |
| 29397 | CO | MD | Occupational Medicine Physician |
| A-884-89 | NM | MD | Occupational Medicine Physician |
| 836 | NV | MD | Occupational Medicine Physician |
| 6289 | WY | MD | Occupational Medicine Physician |
| 2191 | IA | MD | Medical 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.