Bradley Jack Tishman

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO219893 Issued in OR

Practice address

506 4TH St
La Grande, OR 97850-1906

Phone

(541) 663-3138

Fax

(541) 975-5120

NPI assigned

May 19, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Family Practice

Education

Lake Erie Col of Osteo Med at Seton Hill Univ, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grande Ronde Hospital IncGroup PAC ID 0547170789, 97 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grande Ronde Hospital Home Care Services Home health agency, La Grande, OR, CCN 387037
• Grande Ronde Hospital Hospital, La Grande, OR, CCN 381321

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: btishman3435313@wm.providencedirect.org

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.

• Grande Ronde Hospital, Inc.

  • Critical Access Hospital
  • La Grande, OR
  • NPI 1467446195
  Medicare reassignment Care Compare group NPD
• Grande Ronde Hospital, Inc.

  • Rural Health Clinic/Center
  • La Grande, OR
  • NPI 1093296519

  Family Medicine

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grande Ronde Hospital

  • Pediatrics Physician
  • La Grande, OR
  • NPI 1861434615

  Hospital

  Care Compare affiliation
• Grande Ronde Hospital Inc.

  • Obstetrics & Gynecology Physician
  • La Grande, OR
  • NPI 1972545895

  Hospital

  Care Compare affiliation
• Grande Ronde Hospital, Inc

  • Home Health Agency
  • La Grande, OR
  • NPI 1285664037
  Care Compare affiliation
• Grande Ronde Hospital, Inc.

  • Primary Care Clinic/Center
  • La Grande, OR
  • NPI 1174553929

  Hospital

  Care Compare affiliation
• Grande Ronde Hospital, Inc.

  • Critical Access Hospital
  • La Grande, OR
  • NPI 1467446195
  Care Compare affiliation

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1033783584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PRISMA HEALTH MEDICAL GROUP FAMILY MEDICINE CENTER",
            "address_2": "3209 COLONIAL DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-6113",
            "fax_number": "803-434-8478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501906",
            "telephone_number": "541-663-3138",
            "fax_number": "541-975-5120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Prisma Health Medical Group Family Medicine Center",
            "address_2": "3209 Colonial Drive",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "29203",
            "country_code": "US",
            "telephone_number": "803-434-6113",
            "fax_number": "803-434-8478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISHMAN",
        "first_name": "BRADLEY",
        "middle_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-19",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO219893",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linna A Thompson, MS, CCC-SLP
• Kristian Ryan Thornton
• Thrifty Payless Inc
• Amber Tiedemann, VQMHP
• Rebecca Tilley, RNFA
• Naghmeh Tishman
• Bryan Tolle, D.O.
• Michelle Tolle, D.O.
• Tracey Kathleen Tracy, MD
• Transire, LLC

• Family Medicine Physician in La Grande, OR
• Providers in La Grande, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.