Bradley C Stufflebam, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036-058847 Issued in IL

Practice address

629 Sable Dr
Centralia, IL 62801-4472

Phone

(618) 533-0727

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. 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

Doctor of Medicine

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 and National Provider Directory roles.

• Dav-Kim Portable X Ray Service Co

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Skokie, IL
  • NPI 1841441821
  NPD (past)
• Xcel Diagnostics LLC

  • Mobile Radiology Clinic/Center
  • Skokie, IL
  • NPI 1770917288
  NPD (past)
• Biotech X-Ray Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Saint Louis, MO
  • NPI 1437108842
  NPD (past)
• Bluff Radiology Group, LLC

  • Diagnostic Radiology Physician
  • Poplar Bluff, MO
  • NPI 1881647725
  NPD (past)
• Cape Radiology Group, P.C.

  • Diagnostic Radiology Physician
  • Cape Girardeau, MO
  • NPI 1477506392
  NPD (past)
• PCH Radiology PC

  • Diagnostic Radiology Physician
  • Ponca City, OK
  • NPI 1588845127
  NPD (past)
• Rolla Radiology Group, LLC

  • Diagnostic Radiology Physician
  • Rolla, MO
  • NPI 1780638270
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1275558249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 SABLE DR",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628014472",
            "telephone_number": "618-533-0727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 SABLE DR",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628014472",
            "telephone_number": "618-533-0727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUFFLEBAM",
        "first_name": "BRADLEY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036-058847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "036-058847",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sthomas Sehy DPM LLC
• Megan Elizabeth Stinnett
• Rex Stombaugh, PA
• Heather Stover
• Linda S Stover, MSED LCPC
• Wendy Suey
• Erica L Summers
• George Sun, MD
• Suresh Krishnamoorthy MD SC
• Scott Allen Tate, PT

• Diagnostic Radiology Physician in Centralia, IL
• Providers in Centralia, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.