Active NPI
Stephen K Bradley, MD
- Anesthesiology Physician
- Salt Lake City, UT
National Provider Identifier
1508950296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 172488-1205
- Practice address
- 1795 S Devonshire Dr
Salt Lake City, UT 84108-2562 - Phone
- (801) 860-5905
- Fax
- (855) 242-1691
- NPI assigned
- Oct 3, 2006
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 172488-1205 | UT | Primary |
Addresses
Primary practice location
1795 S Devonshire Dr
Salt Lake City, UT 84108-2562
Mailing address
1795 S Devonshire Dr
Salt Lake City, UT 84108-2562
Phone (801) 860-5905
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PRA07396 | Other | UT | MOLINA |
| QM0000075886 | Other | UT | ALTIUS |
| 002086464 | Medicaid | NV | |
| 17839 | Other | UT | DESERET MUTUAL |
| 103500200 | Medicaid | WY | |
| 1502954 | Other | UT | UMWA |
| 44140 | Other | UT | HEALTHY U |
| 820771 | Medicaid | AZ | |
| 107006512102 | Other | UT | IHC |
| 73544 | Other | UT | PEHP |
| 806727300 | Medicaid | ID | |
| 2090168 | Other | UT | UNITED HEALTHCARE |
| 870545614SB3 | Other | UT | EDUCATORS MUTUAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 172488-1205 | UT | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618963200000",
"number": "1508950296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1795 S DEVONSHIRE DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841082562",
"telephone_number": "801-860-5905",
"fax_number": "855-242-1691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1795 S DEVONSHIRE DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841082562",
"telephone_number": "801-860-5905",
"fax_number": "855-242-1691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "STEPHEN",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2021-04-21",
"certification_date": "2021-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "UT",
"license": "172488-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA",
"identifier": "PRA07396",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "QM0000075886",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002086464",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DESERET MUTUAL",
"identifier": "17839",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103500200",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA",
"identifier": "1502954",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY U",
"identifier": "44140",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "820771",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC",
"identifier": "107006512102",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "73544",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806727300",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2090168",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATORS MUTUAL",
"identifier": "870545614SB3",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.