Samuel W Bradberry, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

14195 Issued in TN

Practice address

1020 Reelfoot Ave
Union City, TN 38261

Phone

(731) 885-5131

Fax

(731) 885-5335

NPI assigned

Jan 18, 2006

Last updated

Mar 2, 2012By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dyersburg Family Walk-in Clinic LLC

  dba Reelfoot Family Walk-In Clinic

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1174712780
  Medicare reassignment
• Doctors' Clinic of Union City, P.C.

  • Family Medicine Physician
  • Union City, TN
  • NPI 1346381878
  NPD (past) Authorized official
• Baptist Memorial Medical Group Inc

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1306089206

  Family Medicine

  NPD
• Baptist Memorial Medical Group Inc

  dba BMG East Memphis Pharmacy

  • Community/Retail Pharmacy
  • Memphis, TN
  • NPI 1841006129
  NPD (past)

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330646400000",
    "number": "1588644397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 405827",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303845827",
            "telephone_number": "870-934-5871",
            "fax_number": "870-934-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 REELFOOT AVE",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "38261",
            "telephone_number": "731-885-5131",
            "fax_number": "731-885-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADBERRY",
        "first_name": "SAMUEL",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2012-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "14195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080091652",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3002040",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edna M Black
• Marvin Asbury Blanton III, MD
• James Dylan Bondurant, O.D.
• Boyce Randall Leduke DDS
• Sara Brackeen
• Melinda Brooks, LPC
• Bruce B Brown, M.D.
• Tony Brown
• Tye D Browning, P.A.
• Alexandra Buckland, APRN-FNP

• Family Medicine Physician in Union City, TN
• Providers in Union City, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.