Brad Clayton Barth, M.D. – Anesthesiology Physician

Key facts

NPI: 1104894336
Entity type: Individual (NPI type 1)
Primary specialty: Anesthesiology Physician 207L00000X
License: A66743 (CA)
Practice address: 1401 Bailey Ave
Needles, CA 92363-3103
Phone: (760) 326-7141
Fax: (760) 326-7167
NPI assigned: Mar 14, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 3

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.

Community Healthcare Partner, Inc Critical Access Hospital · Needles, CA · NPI 1457520942

Medicare reassignment NPD CA
Community Healthcare Partner, Inc Diagnostic Radiology Physician · Needles, CA · NPI 1336526086

NPD
Medstat Anesthesia Consultants Anesthesiology Physician · Fort Mohave, AZ · NPI 1962573436

NPD (past) ANESTHESIOLOGY

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20140226002173	CA	Practitioner - Anesthesiology Practitioner - General Practice	8729009006	Reassigns benefits to 1 organization Practice locations: Needles, CA

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
66743	CA	MD	Mental Health Counselor
A66743	CA	MD	General Practice Physician

Practice roles

Organization	Specialty	Status	New patients
Community Healthcare Partner, Inc		Current since Oct 19, 2013	Accepting new patients
Community Healthcare Partner, Inc		Current since Oct 19, 2013	Accepting new patients
Medstat Anesthesia Consultants	Anesthesiology	Past	Accepting new patients

Locations

1401 Bailey Ave
Needles, CA 92363
Phone (760) 326-4531

Interoperability endpoints

FHIR API: https://fhir-usa.unify.chbase.com/org/coriver-af76f87f

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Anesthesiology Physician	207L00000X	A66743	CA	Yes
General Practice Physician	208D00000X	A66743	CA

Addresses

Primary practice location

1401 Bailey Ave
Needles, CA 92363-3103

Mailing address

1401 Bailey Ave
Needles, CA 92363-3103
Phone (760) 326-7141

Other identifiers

Identifier	Type	State	Issuer
00A667430	Medicaid	CA
443341	Medicaid	AZ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 26, 2013.

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1104894336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 BAILEY AVE",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923633103",
            "telephone_number": "760-326-7141",
            "fax_number": "760-326-7167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 BAILEY AVE",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923633103",
            "telephone_number": "760-326-7141",
            "fax_number": "760-326-7167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTH",
        "first_name": "BRAD",
        "middle_name": "CLAYTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A66743",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A66743",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A667430",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "443341",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Needles, CA

All providers in Needles, CA · Anesthesiology Physician in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.