NPIMap

Individual provider Active NPI

Bradley Thomas Corbin

  • Obstetrics & Gynecology Physician
  • Orange Park, FL
National Provider Identifier
1104259548
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME158618 Issued in FL
Practice address
1825 Kingsley Ave Ste 390
Orange Park, FL 32073-4484
Phone
(904) 639-2260
Fax
(904) 272-1986
NPI assigned
Aug 20, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME158618 FL Primary
Obstetrics & Gynecology Physician 207V00000X 5171975 ID

Addresses

Primary practice location

1825 Kingsley Ave Ste 390
Orange Park, FL 32073-4484

Mailing address

1825 Kingsley Ave Ste 390
Orange Park, FL 32073-4484
Phone (904) 639-2260

Other practice location 1

100 E Idaho St Ste 302
Boise, ID 83712-6269
Phone (208) 343-7501

Other identifiers 1

IdentifierTypeStateIssuer
100088853MedicaidWI

Electronic endpoints 3

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/Documentsubmission/2_0/Nhinservice/XDRRequest_Service Other Ability Network
Direct Messaging Address bcorbin439492@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, FL, ID3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20220829001104 WI Practitioner - Obstetrics/Gynecology 4284963802 Reassigns benefits to 3 organizations
I20230204000194 FL Practitioner - Obstetrics/Gynecology 4284963802
I20250917000866 ID Practitioner - Obstetrics/Gynecology 4284963802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Mercer University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians
Aspirus Rhinelander and Tomahawk Hospitals and Clinics, Inc.Group PAC ID 9335059856, shared by 17 NPIs, 566 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

100 E Idaho St
Boise, ID 83712-6269

2251 N Shore Dr
Rhinelander, WI 54501-6710

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

855 N Westhaven Dr
Oshkosh, WI 54904-7668
Phone (920) 303-8700

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019

Merit-based Incentive Payment System (MIPS)

Final score
85.52 of 100Reported as group
Quality
78.57
Promoting interoperability
99
Improvement activities
40
Cost
74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5171975IDMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Obhg Wisconsin, S.C. Obstetrics & Gynecology CurrentSince May 4, 2022 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Obstetrics & Gynecology CurrentSince Sep 3, 2025 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 20, 2025 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Aurora Medical Group, Inc. Obstetrics & Gynecology CurrentSince Sep 20, 2025 Accepting new patients
Memorial Family Practice Associates LLC PastSince Nov 20, 2022 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

100 E Idaho St
Ste 302
Boise, ID 83712
Phone (208) 343-7501

29980 Network Pl
Chicago, IL 60673

777 Lowndes Hill Rd
Bldg 1
Greenville, SC 29607
Phone (864) 908-3736

400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

855 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 451-5643

2251 N Shore Dr
Rhinelander, WI 54501
Phone (715) 361-2300

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

401 W Mohawk Dr
Ste 100
Tomahawk, WI 54487
Phone (715) 453-7700

8901 W Lincoln Ave
West Allis, WI 53227
Phone (414) 328-6000

Interoperability endpoints

  • Direct secure messaging: bcorbin380074@direct.aspirus.org
  • Direct secure messaging: bcorbin439492@direct.myadvocateaurora.org

Organizations & group practices 8

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.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1104259548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 KINGSLEY AVE STE 390",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734484",
            "telephone_number": "904-639-2260",
            "fax_number": "904-272-1986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 KINGSLEY AVE STE 390",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734484",
            "telephone_number": "904-639-2260",
            "fax_number": "904-272-1986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Idaho St Ste 302",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837126269",
            "country_code": "US",
            "telephone_number": "208-343-7501",
            "fax_number": "208-336-8248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORBIN",
        "first_name": "BRADLEY",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-20",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME158618",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "5171975",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100088853",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/Documentsubmission/2_0/Nhinservice/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bcorbin439492@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "855 N Westhaven Dr",
            "city": "Oshkosh",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549047668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "855 N Westhaven Dr",
            "city": "Oshkosh",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549047668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.