Bradley Keith Shields

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

903096 Issued in MS

Practice address

128 Earl Clark Dr
Florence, MS 39073-6604

Phone

(601) 891-8465

Fax

(601) 891-8468

NPI assigned

Jan 2, 2019

Last updated

Jan 2, 2019By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IAFCAA

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.

• South Rankin Family Clinic, LLC

  • Family Medicine Physician
  • Richland, MS
  • NPI 1629143334
  Medicare reassignment NPD

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

{
    "created_epoch": "1546387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1073086005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 EARL CLARK DR",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "390736604",
            "telephone_number": "601-891-8465",
            "fax_number": "601-891-8468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 EARL CLARK DR",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "390736604",
            "telephone_number": "601-891-8465",
            "fax_number": "601-891-8468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "BRADLEY",
        "middle_name": "KEITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-02",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "903096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Robinson, NP
• Abbey Ross, NP
• Julian Sandifer Jr., FNP-C
• Regina Ann Scott, OTRL
• Sally Day Sharp, PMHNP-BC
• Roderick A Shields, MD
• Simpson Community Healthcare, Inc (Harrisville Medical Clinic)
• Eleanor Smith, PT
• Southern Diabetes Care, PLLC (Southern Diabetes Care)
• Frances Darlene Staley, MS

• Nurse Practitioner in Florence, MS
• Providers in Florence, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; 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.

Verify at the official NPI Registry.