Individual provider Active NPI

Bradley Jonathan Tennant, DO

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1053816397
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
CDRH.0065608 Issued in CO
Practice address
4105 Briargate Pkwy Ste 125
Colorado Springs, CO 80920-3482
Phone
(303) 338-4545
NPI assigned
Mar 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CDRH.0065608 CO Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

4105 Briargate Pkwy Ste 125
Colorado Springs, CO 80920-3482

Mailing address

10350 E Dakota Ave
Denver, CO 80247-1314

Other identifiers 2

IdentifierTypeStateIssuer
9000195191MedicaidCO
029158OtherCOKAISER COMMERCIAL NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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

Enrollment IDStateProvider typePAC IDDetails
I20210824001494 CO Practitioner - Family Practice 0941605364 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie Col of Osteo Med at Seton Hill Univ, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Colorado Permanente Medical Group PCGroup PAC ID 1254238454, 1,325 clinicians

Practice addresses (Care Compare)

4105 Briargate Pkwy
Suite 125
Colorado Springs, CO 80920-3482
Phone (303) 338-4545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Permanente Medical Group, P.C. CurrentSince Aug 2, 2021 Accepting new patients

Locations

4105 Briargate Pkwy
Ste 125
Colorado Springs, CO 80920
Phone (719) 282-2440

10350 E Dakota Ave
Denver, CO 80247
Phone (303) 636-3350

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1053816397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10350 E DAKOTA AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802471314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 BRIARGATE PKWY STE 125",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809203482",
            "telephone_number": "303-338-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENNANT",
        "first_name": "BRADLEY",
        "middle_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "CDRH.0065608",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000195191",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "029158",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4105 Briargate Pkwy Ste 125",
            "city": "Colorado Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "809203482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.