NPIMap

Individual provider Active NPI

Eloise Daniel Bradham, M.D

  • Anesthesiology Physician
  • Sullivans Island, SC
National Provider Identifier
1194767905
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
13644 Issued in SC
Practice address
3109 Ion Ave
Sullivans Island, SC 29482-8606
Phone
(843) 870-7518
NPI assigned
Jun 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 13644 SC
Anesthesiology Physician 207L00000X 13644 SC Primary

Addresses

Primary practice location

3109 Ion Ave
Sullivans Island, SC 29482-8606

Mailing address

PO Box 126
Sullivans Island, SC 29482-0126
Phone (843) 870-7518

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
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Apollomd Group Services, LLC Anesthesiology Past Accepting new patients
Anesthesia Network Services, LLC Anesthesiology Past Accepting new patients
Nicholas a Straney DPM Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1194767905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "city": "SULLIVANS ISLAND",
            "state": "SC",
            "postal_code": "294820126",
            "telephone_number": "843-870-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 ION AVE",
            "city": "SULLIVANS ISLAND",
            "state": "SC",
            "postal_code": "294828606",
            "telephone_number": "843-870-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADHAM",
        "first_name": "ELOISE",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "13644",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "13644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivans Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.