Renate Marie Braddy, QMHP-A

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

416 S Main St
Estill Springs, TN 37330-4037

Phone

(276) 617-0512

NPI assigned

Jun 26, 2019

Last updated

Jun 26, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Blueprint Integrative Mental Health, LLCGroup PAC ID 1658865068, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blueprint Integrative Mental Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Franklin, TN
  • NPI 1881475770
  Medicare reassignment Care Compare group
• Centerstone of Tennessee, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Nashville, TN
  • NPI 1396767430
  NPD
• Centerstone of Tennessee, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manhattan, KS
  • NPI 1023900651
  NPD

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1154982593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 S MAIN ST",
            "city": "ESTILL SPRINGS",
            "state": "TN",
            "postal_code": "373304037",
            "telephone_number": "276-617-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 S MAIN ST",
            "city": "ESTILL SPRINGS",
            "state": "TN",
            "postal_code": "373304037",
            "telephone_number": "276-617-0512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDY",
        "first_name": "RENATE",
        "middle_name": "MARIE",
        "credential": "QMHP-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS LICENSE",
            "identifier": "0732004484",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://centerstone.org/locations/tennessee/facilities/centerstone-estill-springs-south-main-street/",
            "affiliation": "N",
            "endpointDescription": "Place of employment",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "416 S Main St",
            "city": "Estill Springs",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373304037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Allied Mobile Imaging, LLC
• Amg-Southern Tennessee LLC (Family Physicians of Estill Springs)
• Robert Anderson
• Debra Jane Baxter, LCSW
• Walter J Boyanton III, MD
• James Randolph Bradford, DPH
• Rose Ann Bryant, RN
• Tiffany Burris
• William Alan Cleek, MA,ED.S.
• Harold Randall Davis

• Mental Health Counselor in Estill Springs, TN
• Providers in Estill Springs, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.