Bradley R Dirks, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001213 Issued in IA

Practice address

1251 W Cedar Loop
Cherokee, IA 51012-1599

Phone

(712) 225-2594

Fax

(712) 225-1684

NPI assigned

Apr 19, 2006

Last updated

Jul 31, 2009By the provider in NPPES

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Plains Area Mental Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Le Mars, IA
  • NPI 1356198147
  NPD (past)
• Plains Area Mental Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Le Mars, IA
  • NPI 1801867734
  NPD (past)

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248998400000",
    "number": "1235194648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 W CEDAR LOOP",
            "city": "CHEROKEE",
            "state": "IA",
            "postal_code": "510121599",
            "telephone_number": "712-225-2594",
            "fax_number": "712-225-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 W CEDAR LOOP",
            "city": "CHEROKEE",
            "state": "IA",
            "postal_code": "510121599",
            "telephone_number": "712-225-2594",
            "fax_number": "712-225-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRKS",
        "first_name": "BRADLEY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2009-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• County of Cherokee (Cherokee County Community Health and Home Care)
• Benjamin R Cox, C.R.N.A.
• Jamie Kay Werner Crum, FNP-BC, CDCES
• Brenda Jean Deroo, ARNP
• Benjamin John Deubner, D.P.T.
• Lisa M. Ducommun, CNP
• Jane Ebert
• Cheryl Ellis
• Family Vision Clinic
• Stewart A Fern

• Physician Assistant in Cherokee, IA
• Providers in Cherokee, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; 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.