Individual provider Active NPI

Jessica Rae Bradley, PSY.D.

  • Clinical Psychologist
  • Huntington, WV
National Provider Identifier
1245972710
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1283 Issued in WV
Practice address
1115 20TH St Ste 205
Huntington, WV 25703-2071
Phone
(304) 691-1500
NPI assigned
Apr 13, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1283 WV Primary

Addresses

Primary practice location

1115 20TH St Ste 205
Huntington, WV 25703-2071

Mailing address

1115 20TH St Ste 205
Huntington, WV 25703-2071
Phone (304) 691-1500

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Jessica.bradley@marshall.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220627001469 WV Practitioner - Clinical Psychologist 2668851320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1115 20TH St
Suite 205
Huntington, WV 25703-2071
Phone (304) 691-1500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1283WVMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Highlands Community Mental Health Center, Inc. Clinical CurrentSince Aug 18, 2023 Accepting new patients
University Physicians & Surgeons, Inc CurrentSince Jul 1, 2022 Accepting new patients
University Physicians & Surgeons, Inc. CurrentSince Jul 1, 2022 Accepting new patients

Locations

1600 Medical Center Dr
Ste 3500
Huntington, WV 25701
Phone (304) 691-1300

1115 20th St
Ste 205
Huntington, WV 25703
Phone (304) 691-1100

1448 10th Ave
Ste 304
Huntington, WV 25701
Phone (304) 691-6381

200 12th Street Ext
Princeton, WV 24740
Phone (304) 425-9541

Interoperability endpoints

  • Direct secure messaging: jessica.bradley@marshall.cernerdirect.com

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1245972710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 20TH ST STE 205",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257032071",
            "telephone_number": "304-691-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 20TH ST STE 205",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257032071",
            "telephone_number": "304-691-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "JESSICA",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WV",
            "license": "1283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jessica.bradley@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1115 20th St Ste 205",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257032071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

Verify at the official NPI Registry.