Ladonna J Bryan, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Practice address

1600 W Walnut St
Passavant Surgical Associates
Jacksonville, IL 62650-1136

Phone

(217) 479-5821

Fax

(217) 243-7406

NPI assigned

Aug 29, 2006

Sex

Female

Sole proprietor

No

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.

• Passavant Physician Association

  • Multi-Specialty Clinic/Center
  • Jacksonville, IL
  • NPI 1962689307

  Surgery

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 7, 2023.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1508975285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "address_2": "PASSAVANT SURGICAL ASSOCIATES",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501136",
            "telephone_number": "217-479-5821",
            "fax_number": "217-243-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "address_2": "PASSAVANT SURGICAL ASSOCIATES",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501136",
            "telephone_number": "217-479-5821",
            "fax_number": "217-243-7406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "LADONNA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111023 1",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111023 2",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Braden Partners LP
• Robert Frederick Bradley, DDS
• Tamara Breckon
• Nathan Brown, PHARMD
• Kerstin Autumn Bruere
• Bushnell Dix Hill Jones 694110
• Jamie D Buss, DT
• Ashley Colleen Byers
• Care Center of Jacksonville, LLC
• Casey Family Chiropractic LLC

• All providers in Jacksonville, IL
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.