Individual provider Active NPI

Bradley M Tran, M.D.

  • Specialist
  • Jacksonville, FL
National Provider Identifier
1366445991
Registry record updated Jan 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME122131 Issued in FL
Practice address
4085 University Blvd S
Suite 3
Jacksonville, FL 32216-4357
Phone
(904) 448-4180
Fax
(904) 448-4184
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A60531 CA
Physical Medicine & Rehabilitation Physician 208100000X MD2014-0144 NM
Specialist 174400000X ME122131 FL Primary

Addresses

Primary practice location

4085 University Blvd S
Suite 3
Jacksonville, FL 32216-4357

Mailing address

4085 University Blvd S
Suite 3
Jacksonville, FL 32216-4357
Phone (904) 448-4180

Other identifiers 1

IdentifierTypeStateIssuer
P00085800OtherCAMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150209000468 FL Practitioner - Pain Management 6305999269 Reassigns benefits to 1 organization
I20230601002908 NV Practitioner - Pain Management 6305999269 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2014-0144NMMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Wellness and Pain Care of Las Vegas, Inc. Physical Medicine & Rehabilitation CurrentSince May 16, 2023 Accepting new patients
Center for Wellness and Pain Care of Las Vegas Inc Physical Medicine & Rehabilitation CurrentSince May 16, 2023 Accepting new patients
Neurology Partners, PA Specialist CurrentSince Jan 26, 2015 Accepting new patients

Locations

4085 University Blvd
#3
Jacksonville, FL 32216

4085 University Blvd S
Ste 3
Jacksonville, FL 32216
Phone (904) 448-4174

1701 N Green Valley Pkwy
Ste 7B
Henderson, NV 89074
Phone (702) 476-9700

401 N Buffalo Dr
Ste 202
Las Vegas, NV 89145
Phone (702) 476-9700

6930 S Cimarron Rd
Ste 260
Las Vegas, NV 89113
Phone (702) 476-9700

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421193600000",
    "number": "1366445991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4085 UNIVERSITY BLVD S",
            "address_2": "SUITE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164357",
            "telephone_number": "904-448-4180",
            "fax_number": "904-448-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4085 UNIVERSITY BLVD S",
            "address_2": "SUITE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164357",
            "telephone_number": "904-448-4180",
            "fax_number": "904-448-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "BRADLEY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2015-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A60531",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NM",
            "license": "MD2014-0144",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME122131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00085800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.