NPIMap

Individual provider Active NPI

Autumn Rejoice Bridger, D.O.

  • Urology Physician
  • Meadville, PA
National Provider Identifier
1609003656
Registry record updated Oct 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
OS016885 Issued in PA
Practice address
505 Poplar St
209
Meadville, PA 16335-3057
Phone
(814) 373-2156
Fax
(814) 373-2159
NPI assigned
Jun 17, 2009
Last updated
Oct 14, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Urology Physician 208800000X OS016885 PA Primary

Addresses

Primary practice location

505 Poplar St
209
Meadville, PA 16335-3057

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 373-2156

Other identifiers 1

IdentifierTypeStateIssuer
102944294MedicaidPA

Other names 1

  • Autumn Rejoice Hubbard Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180810002963 ID Practitioner - Urology 9739305400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Midwestern University, Chicago College of Osteopathic Med, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

1906 Fairview Ave
Suite 350
Caldwell, ID 83605-5425
Phone (208) 454-9181

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Urology CurrentSince Jul 20, 2018 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jul 20, 2018 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients
Primary Care Services Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

1906 Fairview Ave
Ste 350
Caldwell, ID 83605
Phone (208) 454-9181

Interoperability endpoints

  • Direct secure messaging: abridger106207@direct.slhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1609003656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-373-2156",
            "fax_number": "814-373-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 POPLAR ST",
            "address_2": "209",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353057",
            "telephone_number": "814-373-2156",
            "fax_number": "814-373-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGER",
        "first_name": "AUTUMN",
        "middle_name": "REJOICE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-17",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "OS016885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102944294",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "HUBBARD",
            "middle_name": "REJOICE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

Verify at the official NPI Registry.