Bradley Shaw

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P0002005 Issued in AR

Practice address

3708 Robinwood Cir
Bryant, AR 72022-8374

Phone

(501) 993-5465

NPI assigned

Oct 8, 2014

Sex

Male

Sole proprietor

Yes

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 AR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Arkansas Health Group

  dba Baptist Health Behavioral Services Clinic

  • Psychiatry Physician
  • Bryant, AR
  • NPI 1871959874

  Professional

  Medicare reassignment Care Compare group NPD
• Arkansas Health Group

  dba Baptist Health Women's Clinic Arkadelphia

  • Obstetrics & Gynecology Physician
  • Arkadelphia, AR
  • NPI 1720417835
  NPD
• Arkansas Health Group

  dba Baptist Health Surgical Clinic-Stuttgart

  • Surgery Physician
  • Stuttgart, AR
  • NPI 1952840555
  NPD

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412726400000",
    "number": "1104229871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3708 ROBINWOOD CIR",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720228374",
            "telephone_number": "501-993-5465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3708 ROBINWOOD CIR",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720228374",
            "telephone_number": "501-993-5465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "BRADLEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-08",
        "last_updated": "2014-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P0002005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kady Self, PTA
• Micah Self
• Sarah Self
• Dominique Nicole Seng, PHARMD
• Ashley Brooke Sexton, PTA
• Reed Shaw, PHARMD
• Rosetta Marie Shelby-Calvin, DMD
• Chelsea Suzanne Shelman, PHARM.D
• Leanne Nicole Shepherd, COTA
• Shepherd's Grace Home Health

• Professional Counselor in Bryant, AR
• Providers in Bryant, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.