Active NPI
Andrew Ryan Bradbury, MD
- Family Medicine Physician
- Idaho Falls, ID
National Provider Identifier
1447837364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M-17116
- Practice address
- 333 S Woodruff Ave
Idaho Falls, ID 83401-4322 - Phone
- (208) 413-7917
- NPI assigned
- Mar 26, 2021
- Last updated
- Jul 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M-17116 | ID | Primary |
Addresses
Primary practice location
333 S Woodruff Ave
Idaho Falls, ID 83401-4322
Mailing address
1641 Sunny Pine Way
Idaho Falls, ID 83404-8255
Phone (208) 403-7774
Other names 1
- Ryan Bradbury
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 2, 2024 through Jul 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-17116 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellberry PLLC | Family Medicine | Current | Accepting new patients |
Locations
333 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 522-2591
Interoperability endpoints
- andrew.bradbury@hca3.eclinicaldirectplus.com
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721347200000",
"number": "1447837364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1641 SUNNY PINE WAY",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834048255",
"telephone_number": "208-403-7774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 S WOODRUFF AVE",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834014322",
"telephone_number": "208-413-7917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADBURY",
"first_name": "ANDREW",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-26",
"last_updated": "2024-07-19",
"certification_date": "2024-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M-17116",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RYAN",
"last_name": "BRADBURY",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.