NPIMap

Organization Active NPI

Bradley W Greider MD Inc

  • Ophthalmology Physician
  • Vista, CA
National Provider Identifier
1104923705
Registry record updated Nov 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
BRADLEY W GREIDER MD INC
Practice address
2067 W Vista Way
Ste 120
Vista, CA 92083-6031
Phone
(760) 758-2020
Fax
(760) 758-1410
NPI assigned
Sep 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2020

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

Authorized official

Name
Mr. Bradley William Greider, MDNPI 1508979006
Title
President Owner
Phone
(760) 758-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

2067 W Vista Way
Ste 120
Vista, CA 92083-6031

Mailing address

2067 W Vista Way
Ste 120
Vista, CA 92083-6031
Phone (760) 758-2020

Other identifiers 1

IdentifierTypeStateIssuer
00G464610MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051206000822 CA Part B Supplier - Clinic/Group Practice 2062432982 Receives reassigned benefits from 12 practitioners
Practice locations: Vista, CA
O20100930014183 CA DME Supplier - Physician - OphthalmologyDME Supplier - Physician - OptometristDME Supplier - Optician 2062432982 Practice locations: Vista, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Bradley W Greider MD Inc2067 W Vista Way, Vista, CA 92083-6032(760) 758-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Sep 16, 1988

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • Direct secure messaging: sgiang@greidereye.intellechartdirect.net
  • Direct secure messaging: bstephens@greidereye.intellechartdirect.net
  • Direct secure messaging: bchen@greidereye.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605052800000",
    "number": "1104923705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY",
            "address_2": "STE 120",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836031",
            "telephone_number": "760-758-2020",
            "fax_number": "760-758-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY",
            "address_2": "STE 120",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836031",
            "telephone_number": "760-758-2020",
            "fax_number": "760-758-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY W GREIDER MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-19",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A",
        "authorized_official_last_name": "GREIDER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "760-758-2020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G464610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.