Bradley Dee Mangum, FNP-BC, DC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1573A Issued in ID

Practice address

559 W Washington St
Burns, OR 97720-1441

Phone

(541) 573-2074

NPI assigned

Oct 27, 2009

Last updated

Dec 3, 2020By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WY, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Lincoln County Hospital DistrictGroup PAC ID 4789580218, shared by 4 NPIs, 66 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Star Valley Medical Center Hospital, Afton, WY, CCN 531313
• Memorial Hospital Sweetwater County Hospital, Rock Springs, WY, CCN 531318

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bmangum625225@direct.ochin.org

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.

• North Canyon Medical Center Inc.

  dba North Canyon Medical Center

  • Critical Access Hospital
  • Gooding, ID
  • NPI 1609046671
  Medicare reassignment NPD
• North Lincoln County Hospital District

  dba Star Valley Medical Center

  • Critical Access Hospital
  • Afton, WY
  • NPI 1255376406
  Medicare reassignment NPD
• North Lincoln County Hospital District

  dba Star Valley Medical Center

  • Family Medicine Physician
  • Afton, WY
  • NPI 1730132523
  Medicare reassignment NPD
• North Canyon Medical Center, Inc.

  dba North Canyon Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Gooding, ID
  • NPI 1275703241
  NPD
• North Canyon Medical Center, Inc.

  dba North Canyon Imaging Center Twin Falls

  • Radiology Clinic/Center
  • Twin Falls, ID
  • NPI 1700641636
  NPD
• Davidson Chiropractic Clinic, Inc.

  • Chiropractor
  • Rock Springs, WY
  • NPI 1598935280
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Hospital of Sweetwater County

  dba County of Sweetwater

  • Critical Access Hospital
  • Rock Springs, WY
  • NPI 1558361949
  Care Compare affiliation
• North Lincoln County Hospital District

  dba Star Valley Medical Center

  • Critical Access Hospital
  • Afton, WY
  • NPI 1255376406
  Care Compare affiliation

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1235465147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 W WASHINGTON ST",
            "city": "BURNS",
            "state": "OR",
            "postal_code": "977201441",
            "telephone_number": "541-573-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 W WASHINGTON ST",
            "city": "BURNS",
            "state": "OR",
            "postal_code": "977201441",
            "telephone_number": "541-573-2074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "267 N Canyon Dr",
            "address_2": "Medical Plaza",
            "address_purpose": "LOCATION",
            "city": "Gooding",
            "state": "ID",
            "postal_code": "833305500",
            "country_code": "US",
            "telephone_number": "208-934-4446",
            "fax_number": "208-934-4442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "BRADLEY",
        "middle_name": "DEE",
        "name_prefix": "Dr.",
        "credential": "FNP-BC, DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-27",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "1573A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500763900",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thaddeus Shawn Labhart, CADCII, MAQMHP
• Sarah Lynn Laiosa, DO
• Sarah Lance
• Amanda Jo Lewellen
• Valerie Dawn Long
• Katerina Michelle Marten
• Courtney Colleen McMullen, MA CCC-SLP
• David Michael Mehr, MD
• Joel August Moore, MD
• Lincoln Marcus Mosier, DO

• Family Nurse Practitioner in Burns, OR
• Providers in Burns, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.