Bradley J Fancher, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD12802 Issued in OR

Practice address

10200 SW Eastridge St
Suite 205
Portland, OR 97225-5064

Phone

(503) 280-4555

Fax

(503) 280-4559

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2012 through Oct 1, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Cedar Creek Internal Medicine,PC

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1265517437
  NPD Authorized official

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413158400000",
    "number": "1184733859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 SW EASTRIDGE ST",
            "address_2": "SUITE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255032",
            "telephone_number": "503-280-4555",
            "fax_number": "503-280-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 SW EASTRIDGE ST",
            "address_2": "SUITE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255064",
            "telephone_number": "503-280-4555",
            "fax_number": "503-280-4559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANCHER",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2014-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD12802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Famiy Roots Chiropractic
• Emily Fan, MD
• Guang Fan, MD
• Jessie Fan, MD
• Karen Fan
• Sandy H Fang, M.D.
• Sheng Fang
• Yunjing Fang, M.D.
• Daryn Fanney, D.C.
• Minga Fannin, C-IAYT

• Internal Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.