Bradley Bliss, PAC
Individual provider Active NPI Medical Physician Assistant · Wellston, MI
NPI 1114014180 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1114014180
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5601007455 (MI)
- Practice address
- 14477 Caberfae Hwy
Wellston, MI 49689-9315 - Phone
- (231) 848-4777
- NPI assigned
- Oct 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Wellston Medical Center PLLC
Practice addresses (Care Compare)
14477 Caberfae Hwy
Wellston, MI 49689-9315
Phone (231) 655-0095
Hospital & facility affiliations
- Munson Healthcare Manistee Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050628000927 | MI | Practitioner - Physician Assistant | 4789632373 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaleva Medical Center | Current | Accepting new patients | |
| Lake County Care Center, Inc. | Past | Accepting new patients | |
| Senior Medical Corp. P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601007455 | MI | Yes |
Addresses
Primary practice location
14477 Caberfae Hwy
Wellston, MI 49689-9315
Mailing address
14477 Caberfae Hwy
Wellston, MI 49689-9315
Phone (231) 848-4777
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5601001299 | Other | MI | MICHIGAN PAC LICENSE |
Other providers in Wellston, MI
All providers in Wellston, MI · Medical Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.