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Individual provider Active NPI

Michelle Lea Bradley, DO

  • Physical Medicine & Rehabilitation Physician
  • Saint Clair Shores, MI
National Provider Identifier
1366477572
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
5101012404 Issued in MI
Practice address
25311 Little Mack Ave
Suite B
Saint Clair Shores, MI 48081-3301
Phone
(586) 498-2400
Fax
(586) 498-2800
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 5101012404 MI Primary

Addresses

Primary practice location

25311 Little Mack Ave
Suite B
Saint Clair Shores, MI 48081-3301

Mailing address

8301 Reliable Pkwy
Chicago, IL 60686-0083
Phone (586) 498-2400

Other identifiers 1

IdentifierTypeStateIssuer
1366477572MedicaidMI

Other names 1

  • Dr. Michelle Lea Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040324001618 MI Practitioner - Physical Medicine and Rehabilitation 3173414356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Michigan State University College of Osteopathic Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Great Lakes Physiatrists PCGroup PAC ID 1153217278, 16 clinicians

Practice addresses (Care Compare)

25311 Little Mack Ave
Suite B
Saint Clair Shores, MI 48081-3301
Phone 5864982400111

Hospital & facility affiliations

  • Alpha Therapeutics, PC Home health agency, Warren, MI, CCN 237721
  • McLaren Home Health Home health agency, Clinton Township, MI, CCN 237172
  • McLaren Macomb Hospital, Mount Clemens, MI, CCN 230227
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • McLaren Macomb Inpatient rehabilitation facility, Mount Clemens, MI, CCN 23T227

Merit-based Incentive Payment System (MIPS)

Final score
94.92 of 100Reported as group
Quality
93.88
Improvement activities
40
Cost
69.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101012404MIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Physiatrists PC Physical Medicine & Rehabilitation CurrentSince Jan 1, 2012 Accepting new patients
Macomb Neurology Associates PC Past Accepting new patients
Center for Physical Medicine & Rehabilitation PC Past Accepting new patients
McLaren Macomb Past Accepting new patients

Locations

8301 Reliable Pkwy
Chicago, IL 60686

5669 Lakeshore Rd
Fort Gratiot, MI 48059
Phone (810) 385-7260

50505 Schoenherr Rd
Ste 210
Shelby Township, MI 48315
Phone (586) 884-6681

25311 Little Mack Ave
Ste B
St Clr Shores, MI 48081
Phone (586) 498-2400

Interoperability endpoints

  • Direct secure messaging: mbradley994732@direct.hfhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1366477572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8301 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860083",
            "telephone_number": "586-498-2400",
            "fax_number": "586-498-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25311 LITTLE MACK AVE",
            "address_2": "SUITE B",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813301",
            "telephone_number": "586-498-2400",
            "fax_number": "586-498-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MICHELLE",
        "middle_name": "LEA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5101012404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366477572",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "CLARK",
            "middle_name": "LEA",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.