Garry Lee Brady, DO
Individual provider Active NPI General Practice Physician · Rensselaer, IN
NPI 1457513764 · NPPES record last updated Jul 2, 2024
Key facts
- NPI
- 1457513764
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 02004413A (IN)
- Practice address
- 716 S College Ave
Rensselaer, IN 47978-3083 - Phone
- (219) 866-0485
- Fax
- (219) 866-0837
- NPI assigned
- Jun 27, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140509001308 | IN | Practitioner - General Practice | 5799931705 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 732 | NE | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jasper County After Hours Urgent Care Inc | Current |
Accepting new patients | |
| Christian Clinic PC | Current |
Accepting new patients | |
| Vein Associates of Northwest Indiana LLC | Past |
Accepting new patients |
Locations
718 S College Ave
Rensselaer, IN 47978
Phone (219) 866-0485
716 S College Ave
Rensselaer, IN 47978
Phone (219) 866-0485
919 E Grace St
Rensselaer, IN 47978
Phone (219) 866-0411
Interoperability endpoints
- https://api.platform.athenahealth.com/12167/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 02004413A | IN | Yes |
Addresses
Primary practice location
716 S College Ave
Rensselaer, IN 47978-3083
Mailing address
716 S College Ave
Rensselaer, IN 47978-3083
Phone (291) 866-0485
Other providers in Rensselaer, IN
- Patricia Louise Benedict
- Tracy Marie Rochester Biggs
- Tiffany Bluemke
- Tonya Kay Bonnell
- Kimberly Bousema
- Emily Bridgeman
- John Bryant
- Christian Clinic PC
- Christopher Adam Conn
- Jeffrey D'Angelo
All providers in Rensselaer, IN · General Practice Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2024. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.