Individual provider Active NPI

Bradley A. Otto, MD

  • Otolaryngology Physician
  • Columbus, OH
National Provider Identifier
1114969185
Registry record updated Feb 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
35084019 Issued in OH
Practice address
915 Olentangy River Rd Ste 4000
Columbus, OH 43212-3154
Phone
(614) 366-3687
Fax
(614) 293-6176
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35084019 OH
Otolaryngology Physician 207Y00000X 35084019 OH Primary

Addresses

Primary practice location

915 Olentangy River Rd Ste 4000
Columbus, OH 43212-3154

Mailing address

700 Ackerman Rd Ste 2120
Columbus, OH 43202-1559
Phone (614) 293-2594

Other identifiers 1

IdentifierTypeStateIssuer
2539971MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050323001274 OH Practitioner - Otolaryngology 6406802305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Wright State University Boonshoft School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osu Otolaryngology Head and Neck Surgery LLCGroup PAC ID 9830114529, 66 clinicians

Practice addresses (Care Compare)

410 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 366-3687

450 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 366-3687

452 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 366-3687

460 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 366-3687

6700 University Blvd
Dublin, OH 43016-3508
Phone (614) 366-3687

915 Olentangy River Rd
Columbus, OH 43212-3153
Phone (614) 366-3687

Hospital & facility affiliations

  • Ohio State University State Health System Hospital, Columbus, OH, CCN 360085

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Osu Otolaryngology Head and Neck Surgery LLC Otolaryngology CurrentSince Jul 1, 2009 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

915 Olentangy River Rd
Columbus, OH 43212

915 Olentangy River Rd
Ste 4000
Columbus, OH 43212
Phone (614) 293-9215

700 Ackerman Rd
Ste 570
Columbus, OH 43202
Phone (614) 293-2046

700 Ackerman Rd
Ste 2120
Columbus, OH 43202

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

Interoperability endpoints

  • Direct secure messaging: botto7677@direct.osumc.edu

Organizations & group practices 2

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1114969185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 2120",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021559",
            "telephone_number": "614-293-2594",
            "fax_number": "614-293-4487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 OLENTANGY RIVER RD STE 4000",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432123154",
            "telephone_number": "614-366-3687",
            "fax_number": "614-293-6176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "BRADLEY",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35084019",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35084019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2539971",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.