Bradford Kelly Ence, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

1779331205 Issued in UT

Practice address

39 Professional Way
Suite 1
Payson, UT 84651-1675

Phone

(801) 465-4805

Fax

(801) 465-4354

NPI assigned

Sep 2, 2006

Last updated

Dec 22, 2022By 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 2

Addresses

Other identifiers 7

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT, WA2 enrollments

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 2

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

• Gunnison Valley Hospital

  dba Mid-Utah Family Medicine

  • Rural Health Clinic/Center
  • Gunnison, UT
  • NPI 1255924486
  Medicare reassignment NPD
• Prosser Public Hospital District of Benton County

  dba Prosser Memorial Health

  • Critical Access Hospital
  • Prosser, WA
  • NPI 1306897681
  Medicare reassignment NPD
• Gunnison Valley Hospital

  dba Main Street Family Clinic

  • Rural Health Clinic/Center
  • Manti, UT
  • NPI 1063038628
  NPD
• Gunnison Valley Hospital

  dba Salina Family Medicine

  • Rural Health Clinic/Center
  • Salina, UT
  • NPI 1982001681
  NPD
• Prosser Public Hospital District of Benton County

  dba Prosser Memorial Health Spine Clinic

  • Specialist
  • Walla Walla, WA
  • NPI 1518770155
  NPD
• Prosser Public Hospital District of Benton County

  dba Prosser Specialty Clinic

  • Gastroenterology Physician
  • Prosser, WA
  • NPI 1780495978
  NPD
• Gunnison Valley Hospital

  • Critical Access Hospital
  • Gunnison, UT
  • NPI 1952463036
  NPD (past)

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1588766299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 PROFESSIONAL WAY",
            "address_2": "SUITE 1",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846511675",
            "telephone_number": "801-465-4805",
            "fax_number": "801-465-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENCE",
        "first_name": "BRADFORD",
        "middle_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MN",
            "license": "72827",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "UT",
            "license": "1779331205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870281028BKE",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "233117",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "P00207619",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "10-00159",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "169404",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "81446",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107006732105",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "39 Professional Way",
            "address_2": "Suite 1",
            "city": "Payson",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846511675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elder Assisted Living LLC (Beehive Homes Payson)
• Elk Ridge Family Practice PC
• Chantelle Lena Elmer, DNP
• Emergency Medical Billing LLC
• Emergency Medical Service, Inc
• Britton R Ercanbrack, DO
• Jordan Spencer Ericksen, OD
• Paige Erickson
• Shaun Evans, CRNA
• Michael Rex Ewell, OTR

• Otolaryngology Physician in Payson, UT
• Providers in Payson, UT by specialty
• Otolaryngology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.