Kelly Bradford
Individual provider Active NPI Clinical Social Worker · Independence, KS
NPI 1386906394 · NPPES record last updated Aug 28, 2017
Key facts
- NPI
- 1386906394
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 4705 (KS)
- Practice address
- 1101 Donald Ave
Independence, KS 67301-2001 - Phone
- (620) 331-1748
- NPI assigned
- Jun 14, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Four County Mental Health Center Inc
Practice addresses (Care Compare)
3354 Hwy 160
Independence, KS 67301-7841
Phone (620) 331-1748
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170908000209 | KS | Practitioner - Clinical Social Worker | 2769755057 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 995 | KS | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four County Mental Health Center, Inc. | Current |
Accepting new patients | |
| Four County Mental Health Center Inc | Current |
Accepting new patients |
Locations
3354 Highway 160
Independence, KS 67301
Phone (620) 331-1260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 995 | KS | |
| Clinical Social Worker | 1041C0700X | 4705 | KS | Yes |
Addresses
Primary practice location
1101 Donald Ave
Independence, KS 67301-2001
Mailing address
PO Box 688
Independence, KS 67301-0688
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200875750A | Medicaid | KS |
Other providers in Independence, KS
- Jennifer Michele Beurskens
- Tammy Blaich
- Misti Blair
- Michelle R Blankenship
- Nickalas Boulware
- Rhyder Bruce
- Darlene Barre Bubis
- Deliz Jivon Byrd
- Mary Frances Callarman
- Cancer Center of Kansas, P.a.
All providers in Independence, KS · Clinical Social Worker in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2017. 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.