Ty David Bradford, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA207912 Issued in OR

Practice address

863 Liberty St NE
Salem, OR 97301-2451

Phone

(877) 522-1275

NPI assigned

Oct 26, 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, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ideal Option PLLCGroup PAC ID 6709013105, 90 clinicians

Ideal Telemedicine Services LLCGroup PAC ID 2860726221, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations (25 of 39)

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.

• Ideal Option, PLLC

  • Clinic/Center
  • Kennewick, WA
  • NPI 1457788275

  OR

  Medicare reassignment Care Compare group NPD
• Ideal Telemedicine Services, LLC

  • Clinic/Center
  • Renton, WA
  • NPI 1346754868

  OR

  Medicare reassignment Care Compare group
• Ideal Option, PLLC

  • Clinical Medical Laboratory
  • Kennewick, WA
  • NPI 1841648623
  NPD
• Ideal Option, PLLC

  • Clinic/Center
  • Newport, OR
  • NPI 1366320327
  NPD (past)
• Ideal Telemedicine Services, LLC

  • Clinic/Center
  • Rosedale, MD
  • NPI 1427561828
  NPD (past)

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1053075077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SW 7TH ST STE A205",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572983",
            "telephone_number": "877-522-1275",
            "fax_number": "833-888-7145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "863 LIBERTY ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012451",
            "telephone_number": "877-522-1275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "444 Bruce St",
            "address_purpose": "LOCATION",
            "city": "Yreka",
            "state": "CA",
            "postal_code": "960973450",
            "country_code": "US",
            "telephone_number": "530-842-4121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "TY",
        "middle_name": "DAVID",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-26",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA60273",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA207912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Ann Bradbury
• Braden Partners LP
• Braden Partners LP
• Angelica Lynn Braden
• Amy Anne Bradford
• Gabriela Raquel Bradley, FNP
• Heather Bradshaw, LMFT, LPC
• John K Bradshaw, M.D.
• Kacy Lee Bradshaw, NNP
• Leah Brakebill, SLP

• Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; 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.