NPIMap

Individual provider Active NPI

Bradley Personius, MD

  • Cardiovascular Disease Physician
  • Grants Pass, OR
National Provider Identifier
1417957374
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD21214 Issued in OR
Practice address
520 SW Ramsey Ave
Ste 101
Grants Pass, OR 97527-5573
Phone
(541) 282-6606
Fax
(541) 282-6601
NPI assigned
Jul 21, 2005
Last updated
Nov 15, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD21214 OR Primary

Addresses

Primary practice location

520 SW Ramsey Ave
Ste 101
Grants Pass, OR 97527-5573

Mailing address

520 Medical Center Drive
Ste 200
Medford, OR 97504-4314
Phone (541) 282-6606

Other identifiers 1

IdentifierTypeStateIssuer
151300MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20031222000591 OR Practitioner - Cardiovascular Disease (Cardiology) 1456259977 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Loma Linda University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
AsanteGroup PAC ID 0547177321, 141 clinicians
Asante Three Rivers Medical Center LLCGroup PAC ID 9931197993, 98 clinicians
Southern Oregon Cardiology LLCGroup PAC ID 2264572510, 28 clinicians

Practice addresses (Care Compare)

2825 E Barnett Rd
Medford, OR 97504-8332
Phone (541) 789-7000

500 SW Ramsey Ave
Grants Pass, OR 97527-5554
Phone (541) 472-7000

520 SW Ramsey Ave
Suite 204
Grants Pass, OR 97527-5535
Phone (541) 930-7223

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair28

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Oregon Cardiology LLC Cardiovascular Disease CurrentSince Jan 1, 2010 Accepting new patients
Asante CurrentSince Oct 1, 2002 Accepting new patients
Asante Ashland Community Hospital, LLC CurrentSince May 1, 2018 Accepting new patients
Asante CurrentSince Oct 1, 2002 Accepting new patients
Asante Three Rivers Medical Center, LLC CurrentSince May 1, 2004 Accepting new patients
Cardiology Consultants P.C. Cardiovascular Disease Current Accepting new patients

Locations

280 Maple St
Ashland, OR 97520
Phone (541) 201-4000

500 5th St
Brookings, OR 97415
Phone (541) 412-2000

520 SW Ramsey Ave
Ste 101
Grants Pass, OR 97527
Phone (541) 472-7810

520 SW Ramsey Ave
Ste 204
Grants Pass, OR 97527
Phone (541) 479-8308

2825 E Barnett Rd
Medford, OR 97504
Phone (541) 282-6770

520 Medical Center Dr
Ste 100
Medford, OR 97504
Phone (541) 608-5600

520 Medical Center Dr
Ste 200
Medford, OR 97504
Phone (541) 282-6600

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1417957374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 MEDICAL CENTER DRIVE",
            "address_2": "STE 200",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044314",
            "telephone_number": "541-282-6606",
            "fax_number": "541-282-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SW RAMSEY AVE",
            "address_2": "STE 101",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275573",
            "telephone_number": "541-282-6606",
            "fax_number": "541-282-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSONIUS",
        "first_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD21214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151300",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

Verify at the official NPI Registry.