Active NPI
Justin Thomas Bradshaw, DO
- Ophthalmology Physician
- Augusta, GA
National Provider Identifier
1295577666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 16483
- Practice address
- 1120 15TH St
Augusta, GA 30912-0004 - Phone
- (801) 358-5927
- NPI assigned
- Jun 7, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 16483 | GA | Primary |
Addresses
Primary practice location
1120 15TH St
Augusta, GA 30912-0004
Mailing address
419 Bloedel Reserve Way Apt 101
Martinez, GA 30907-7333
Phone (801) 358-5927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240717002049 | GA | Order and Referring Only - Internal Medicine | 0941745665 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16483 | GA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717718400000",
"number": "1295577666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 BLOEDEL RESERVE WAY APT 101",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309077333",
"telephone_number": "801-358-5927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 15TH ST",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120004",
"telephone_number": "801-358-5927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "JUSTIN",
"middle_name": "THOMAS",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-07",
"last_updated": "2024-06-07",
"certification_date": "2024-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "GA",
"license": "16483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.