NPIMap

Organization Active NPI

Bruce R. Bragonier, MD, a Professional Corporation

  • Orthopaedic Surgery Physician
  • Sebastopol, CA
National Provider Identifier
1578737441
Registry record updated Jan 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
G75427 Issued in CA
Legal business name
BRUCE R. BRAGONIER, MD, A PROFESSIONAL CORPORATION
Practice address
555 Petaluma Ave
Ste B
Sebastopol, CA 95472-4224
Phone
(707) 823-7602
Fax
(707) 823-7625
NPI assigned
Apr 22, 2008
Last updated
Jan 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bruce Robert Bragonier, MDNPI 1134110026
Title
Physician/Owner
Phone
(707) 823-7602

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X G75427 CA Primary

Addresses

Primary practice location

555 Petaluma Ave
Ste B
Sebastopol, CA 95472-4224

Mailing address

555 Petaluma Ave
Ste B
Sebastopol, CA 95472-4224
Phone (707) 823-7602

Other identifiers 1

IdentifierTypeStateIssuer
00G754270MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1578737441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 PETALUMA AVE",
            "address_2": "STE B",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724224",
            "telephone_number": "707-823-7602",
            "fax_number": "707-823-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 PETALUMA AVE",
            "address_2": "STE B",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724224",
            "telephone_number": "707-823-7602",
            "fax_number": "707-823-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE R. BRAGONIER, MD, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "BRAGONIER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "707-823-7602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G75427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G754270",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastopol, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; 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.