Mark W Bradley, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01035245A Issued in IN

Practice address

3601 S 6TH Ave
BLDG 90 (4-116D)
Tucson, AZ 85723-0001

Phone

(520) 792-1450

Fax

(520) 629-1864

NPI assigned

Apr 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Bluffton Health System LLC

  • Internal Medicine Physician
  • Bluffton, IN
  • NPI 1598783045

  Family Medicine

  NPD (past)
• Columbus Urgent Care Center

  • Family Medicine Physician
  • Columbus, IN
  • NPI 1548338635
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1447214309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 S 6TH AVE",
            "address_2": "BLDG 90 (4-116D)",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857230001",
            "telephone_number": "520-792-1450",
            "fax_number": "520-629-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 S 6TH AVE",
            "address_2": "BLDG 90 (4-116D)",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857230001",
            "telephone_number": "520-792-1450",
            "fax_number": "520-629-1864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MARK",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01035245A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100052620",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley Konecnik, DMD, PLLC
• Erin Bradley, MS, BCBA
• Kathryn Elizabeth Bradley, M.D.
• Khy Bradley, MD
• Layla Carol Bradley, FNP
• Melissa R Bradley, D.O.
• Samuel Locke Bradley
• Shauntay Bradley, RN
• Veronica Bradley, LCSW
• Christopher C Bradshaw, MA, LPC #23251 AZ

• Family Medicine Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.