Bradley Russell Meyer, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO-04161 Issued in IA

Practice address

2301 Highway 71 Ste C
Spirit Lake, IA 51360-1184

Phone

(712) 336-3750

Fax

(712) 336-3730

NPI assigned

Oct 5, 2005

Last updated

Aug 28, 2020By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 10, 2023 through Jan 10, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Iowa Hospital Corporation

  dba IMMC Outpatient Pharmacy

  • Pharmacy
  • Des Moines, IA
  • NPI 1003352949
  NPD (past)
• Orthopaedics PC

  • Orthopaedic Surgery Physician
  • Spencer, IA
  • NPI 1861463473
  NPD (past)

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1043207939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 HIGHWAY 71 STE C",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513601184",
            "telephone_number": "712-336-3750",
            "fax_number": "712-336-3730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HIGHWAY 71 STE C",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513601184",
            "telephone_number": "712-336-3750",
            "fax_number": "712-336-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEYER",
        "first_name": "BRADLEY",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "DO-04161",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "5262",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043207939",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Douglas Maeyaert, D.C.
• Denise Marie Magg, R.N.
• Laith Mohamed Mahdi, D.O.
• Amy Marlow, OT
• Ruth Mroch McCleery, LMHC
• Crystal Elizabeth Meyer, ARNP
• Ashley Ann Miller, PTA
• Janelle Garms Miller, P.T.
• Katie Lisa Moorberg, LMSW
• Heather M Morgan, PHARMD, RPH

• Family Medicine Physician in Spirit Lake, IA
• Providers in Spirit Lake, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.