Edward Michael Bradley, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036063765 Issued in IL

Practice address

900 N. 1St Street
Springfield, IL 62702-3749

Phone

(217) 528-7541

Fax

(217) 525-1007

NPI assigned

Oct 17, 2005

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Springfield Obstetric & Gynecologic Associates, S.C.

  • Obstetrics & Gynecology Physician
  • Springfield, IL
  • NPI 1306822093

  Obstetrics & Gynecology

  NPD Authorized official

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1497744171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N. 1ST STREET",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627023749",
            "telephone_number": "217-528-7541",
            "fax_number": "217-525-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "EDWARD",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036063765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036063765",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Alexandria Boyer
• Trinithas Jeanne Boyi, MD
• Ashley M. Boyle, DPT
• Melinda Boyster, CRNA
• Christopher M Bradbury, M.D., PH.D.
• Mallory Bragg
• Anasuya Soumya Brahmamdam, M.D.
• Brains in Motion, LLC.
• Monica Marie Braley, RBT
• Kellie Brand, LCPC

• All providers in Springfield, IL
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.