Jeremy Bradley MD PSC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

31984 Issued in KY

Legal business name

JEREMY BRADLEY MD PSC

Practice address

3122 Commonwealth CT
Owensboro, KY 42303-2258

Phone

(270) 684-7362

Fax

(270) 684-7753

NPI assigned

Jan 18, 2012

Last updated

Jan 26, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy Bradley, M.D.NPI 1851483291

Title

Owner

Phone

(270) 684-7362

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeremy L Bradley, MD

  • Family Medicine Physician
  • Owensboro, KY
  • NPI 1851483291
  NPD (past) Authorized official

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

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1215208608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3122 COMMONWEALTH CT",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423032258",
            "telephone_number": "270-684-7362",
            "fax_number": "270-684-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3122 COMMONWEALTH CT",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423032258",
            "telephone_number": "270-684-7362",
            "fax_number": "270-684-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMY BRADLEY MD PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-684-7362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "31984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64319841",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Owensboro, KY
• Providers in Owensboro, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; 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.