Amanda Jo Bradley, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

10961 Issued in SD

Practice address

305 S State St
Aberdeen, SD 57401

Phone

(605) 622-5100

Fax

(605) 622-4030

NPI assigned

Jun 5, 2007

Last updated

Nov 7, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Sanford School of Medicine of University of South Dakota, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avera St LukesGroup PAC ID 6406764927, 164 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Avera St Lukes Hospital, Aberdeen, SD, CCN 430014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Avera St. Luke's

  dba Avera Internal Medicine Aberdeen

  • Internal Medicine Physician
  • Aberdeen, SD
  • NPI 1215100813
  Medicare reassignment Care Compare group NPD
• Avera St Lukes

  • General Acute Care Hospital
  • Aberdeen, SD
  • NPI 1457309270
  NPD
• Avera St. Lukes

  dba Avera Medical Group Nephrology Aberdeen

  • Nephrology Physician
  • Aberdeen, SD
  • NPI 1477594430
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Avera St Lukes

  • General Acute Care Hospital
  • Aberdeen, SD
  • NPI 1457309270
  Care Compare affiliation

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1336341866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1460",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574021460",
            "telephone_number": "605-622-2876",
            "fax_number": "605-622-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S STATE ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "57401",
            "telephone_number": "605-622-5100",
            "fax_number": "605-622-4030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 E Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585014520",
            "country_code": "US",
            "telephone_number": "701-530-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 E Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585014520",
            "country_code": "US",
            "telephone_number": "701-530-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "AMANDA",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ND",
            "license": "11206",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301087693",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SD",
            "license": "10961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1450785",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• John M Bormes, M.D.
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• Carl Bot, PT
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• Alexis Lee Braun, NP
• Jenna Braun
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• Emergency Medicine Physician in Aberdeen, SD
• Providers in Aberdeen, SD by specialty
• Emergency Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.