NPIMap

Individual provider Active NPI

Brad A Racette, MD

  • Neurology Physician
  • Phoenix, AZ
National Provider Identifier
1174549307
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
65648 Issued in AZ
Practice address
240 W Thomas Rd # 301
Phoenix, AZ 85013-4407
Phone
(602) 406-6262
Fax
(602) 406-6261
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 103753 MO
Neurology Physician 2084N0400X 65648 AZ Primary

Addresses

Primary practice location

240 W Thomas Rd # 301
Phoenix, AZ 85013-4407

Mailing address

240 W Thomas Rd # 301
Phoenix, AZ 85013-4407
Phone (602) 406-6262

Other identifiers 1

IdentifierTypeStateIssuer
208582916MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220408001983 AZ Practitioner - Neurology 2860525300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Northwestern University Feinberg Medical School, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

500 W Thomas Rd
680 DHMG St Joseph's Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Outpatient Surgery Center, LLC Current Accepting new patients
Sjhmc Physician Services CurrentSince Apr 7, 2022 Accepting new patients
St Josephs Pathology Current Accepting new patients
St. Joseph's Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients

Locations

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

2910 N 3rd Ave
Ste 470
Phoenix, AZ 85013
Phone (602) 406-6262

240 W Thomas Rd
Ste 301
Phoenix, AZ 85013
Phone (602) 406-6262

240 W Thomas Rd
#301
Phoenix, AZ 85013
Phone (602) 406-6262

File 56765
Los Angeles, CA 90074

Organizations & group practices 4

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 4

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1174549307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD # 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134407",
            "telephone_number": "602-406-6262",
            "fax_number": "602-406-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD # 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134407",
            "telephone_number": "602-406-6262",
            "fax_number": "602-406-6261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACETTE",
        "first_name": "BRAD",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MO",
            "license": "103753",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "65648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208582916",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4921 Parkview Pl",
            "address_2": "Div Neurology Movement Disorders, Ste 6C",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.