Odie L Bracy III, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

20010368A Issued in IN

Practice address

6555 Carrollton Ave
Indianapolis, IN 46220-1664

Phone

(317) 257-9672

Fax

(317) 257-9674

NPI assigned

Jun 15, 2005

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293580800000",
    "number": "1285639476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6555 CARROLLTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462201664",
            "telephone_number": "317-257-9672",
            "fax_number": "317-257-9674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 CARROLLTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462201664",
            "telephone_number": "317-257-9672",
            "fax_number": "317-257-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACY",
        "first_name": "ODIE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2010-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IN",
            "license": "20010368A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000085922",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100073260",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ava Bracken
• Carole Jane Bracken
• Ragan Brackett, MD, MBA
• William Janika Brackett, MD
• Grace Elizabeth Brackney
• Brad Sammons DDS, PC
• Niceta Bradburn, MD
• Jamie Lee Bradbury, MD
• Amy M Braden, D.O.
• Grace Braden, MA SLP-CF

• Clinical Neuropsychologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Neuropsychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2010; 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.