Mark A Bradford, M.D.
Individual provider Active NPI Pulmonary Disease Physician · Bend, OR
NPI 1295907707 · NPPES record last updated May 29, 2020
Key facts
- NPI
- 1295907707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- MD173710 (OR)
- Practice address
- 2500 NE Neff Rd
Bend, OR 97701-6015 - Phone
- (541) 706-7715
- Fax
- (541) 706-7742
- NPI assigned
- Mar 25, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Pulmonary Disease
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Charles Health System Inc
St Charles Health System Inc
Practice addresses (Care Compare)
211 NW Larch Ave
Family Care
Redmond, OR 97756-1357
Phone (541) 548-2164
2500 NE Neff Rd
Bend, OR 97701-6015
Phone (541) 706-2768
Hospital & facility affiliations
- St Charles Medical Center - Bend
- St Charles Medical Center Prineville
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150722006464 | OR | Practitioner - Pulmonary Disease |
1052581584 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD173710 | OR | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Charles Health System, Inc. | Current |
Accepting new patients | |
| St. Charles Health System, Inc. | Current |
Accepting new patients | |
| St. Charles Health System, Inc. | Current | Accepting new patients | |
| St. Charles Health System, Inc. | Current |
Accepting new patients | |
| St. Charles Health System, Inc. | Current |
Accepting new patients |
Locations
29358 Network Pl
Chicago, IL 60673
2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333
211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164
1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | MD173710 | OR | Yes |
Addresses
Primary practice location
2500 NE Neff Rd
Bend, OR 97701-6015
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (541) 732-7960
Other practice location 1
1698 E McAndrews Rd
Ste 400
Medford, OR 97504-5589
Phone (541) 732-7960
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500688024 | Medicaid | OR |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mbradford101079@secure.stcharleshealthcare.org |
NPI Registry JSON
{
"created_epoch": "1206403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590710400000",
"number": "1295907707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158",
"telephone_number": "541-732-7960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 NE NEFF RD",
"city": "BEND",
"state": "OR",
"postal_code": "977016015",
"telephone_number": "541-706-7715",
"fax_number": "541-706-7742"
}
],
"practiceLocations": [
{
"address_1": "1698 E McAndrews Rd",
"address_2": "Ste 400",
"address_purpose": "LOCATION",
"city": "Medford",
"state": "OR",
"postal_code": "975045589",
"country_code": "US",
"telephone_number": "541-732-7960",
"fax_number": "541-732-7961",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRADFORD",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-25",
"last_updated": "2020-05-29",
"certification_date": "2020-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "OR",
"license": "MD173710",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500688024",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mbradford101079@secure.stcharleshealthcare.org",
"affiliation": "N",
"address_1": "2500 NE Neff Rd",
"city": "Bend",
"state": "OR",
"country_code": "US",
"postal_code": "977016015",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bend, OR
- Boyle Clinics PC
- Edward M Boyle Jr.
- Jody Marie Bradbury
- Braden Partners LP
- Chelsea Bradford
- Stacey Bradford
- Zachary Bradford
- Bradley Pfeiffer DC, PC
- Kathleen Marie Bradley
- Emily K Bradshaw
All providers in Bend, OR · Pulmonary Disease Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2020. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.