Active NPI
Stephen Bradley, PA
- Medical Physician Assistant
- Prosser, WA
National Provider Identifier
1134222011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA10000296
- Practice address
- 740 Memorial St
Prosser, WA 99350-1525 - Phone
- (509) 786-1931
- Fax
- (509) 786-1997
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA10000296 | WA | Primary |
Addresses
Primary practice location
740 Memorial St
Prosser, WA 99350-1525
Mailing address
PO Box 190
Toppenish, WA 98948-0190
Phone (509) 865-6175
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142805 | Other | WA | L & I |
| 4750BR | Other | WA | REGENCE |
| 8296097 | Medicaid | WA | |
| 1306897681 | Other | NPI PROSSER MEMORIAL | |
| 6972 | Other | GROUP HEALTH | |
| 8296097 | Other | WA | CHPW |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yakima Valley Farm Workers Clinic | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Clatskanie, OR
- NPI 1578000345
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208476800000",
"number": "1134222011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 190",
"city": "TOPPENISH",
"state": "WA",
"postal_code": "989480190",
"telephone_number": "509-865-6175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 MEMORIAL ST",
"city": "PROSSER",
"state": "WA",
"postal_code": "993501525",
"telephone_number": "509-786-1931",
"fax_number": "509-786-1997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "STEPHEN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2008-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WA",
"license": "PA10000296",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "142805",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "4750BR",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8296097",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI PROSSER MEMORIAL",
"identifier": "1306897681",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH",
"identifier": "6972",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHPW",
"identifier": "8296097",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prosser, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.