Active NPI
Bradford Smith
- Skilled Nursing Facility
- South Daytona, FL
National Provider Identifier
1285992982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- OTA10222
- Practice address
- 650 Reed Canal Rd
South Daytona, FL 32119-3230 - Phone
- (386) 310-7868
- NPI assigned
- May 1, 2012
- Last updated
- May 1, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | OTA10222 | FL | Primary |
Addresses
Primary practice location
650 Reed Canal Rd
South Daytona, FL 32119-3230
Mailing address
109 N Paul Revere Dr
Daytona Beach, FL 32119-1484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA10222 | FL | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335830400000",
"number": "1285992982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 N PAUL REVERE DR",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321191484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 REED CANAL RD",
"city": "SOUTH DAYTONA",
"state": "FL",
"postal_code": "321193230",
"telephone_number": "386-310-7868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "BRADFORD",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-01",
"last_updated": "2012-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "OTA10222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Daytona, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.