Robbie L Bradley, PAC
Individual provider Active NPI Family Medicine Physician · Crystal River, FL
NPI 1295890762 · NPPES record last updated Aug 10, 2009
Key facts
- NPI
- 1295890762
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- PAC0001893 (FL)
- Practice address
- 6199 W Gulf to Lake Hwy
Crystal River, FL 34429-2679 - Phone
- (352) 795-0644
- Fax
- (352) 795-2950
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121011000297 | FL | Practitioner - Physician Assistant | 3779732524 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PAC0001893 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meadowcrest Family Physicians, P.a. | Family Medicine | Current |
Accepting new patients |
| Meadowcrest Family Practice PA | Family Medicine | Past | Accepting new patients |
Locations
1250 N Vantage Point Dr
Crystal River, FL 34429
Phone (352) 795-0644
6199 W Gulf To Lake Hwy
Crystal River, FL 34429
Phone (352) 795-0644
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73059
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PAC0001893 | FL | Yes |
Addresses
Primary practice location
6199 W Gulf to Lake Hwy
Crystal River, FL 34429-2679
Mailing address
6199 W Gulf to Lake Hwy
Crystal River, FL 34429-2679
Phone (352) 795-0644
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 290310500 | Medicaid | FL |
Other providers in Crystal River, FL
- Blessed Endocare
- Blessed Ones Home Care, LLC
- Erin Lee Blom
- Albert M. Boholst
- Nicholos P Bollin
- Robert L Brockett
- Rozina E Brooks
- Brooksville Hma Physician Management LLC
- Brooksville Hma Physician Management LLC
- Brooksville Hma Physician Management LLC
All providers in Crystal River, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.