Active NPI
Bradley Richard Swanson, DDS MSD
- Endodontics
- South Bend, IN
National Provider Identifier
1013033794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 12010670A
- Practice address
- 54505 26TH Street
Unit E
South Bend, IN 46635 - Phone
- (574) 807-9050
- NPI assigned
- Mar 22, 2007
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 12010670A | IN | Primary |
Addresses
Primary practice location
54505 26TH Street
Unit E
South Bend, IN 46635
Mailing address
3316 S. Twyckenham Drive
South Bend, IN 46614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013033794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3316 S. TWYCKENHAM DRIVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "46614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54505 26TH STREET",
"address_2": "UNIT E",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "46635",
"telephone_number": "574-807-9050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWANSON",
"first_name": "BRADLEY",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DDS MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IN",
"license": "12010670A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.