Active NPI
Bradley Jahnke, D.O.
- Family Medicine Physician
- Oviedo, FL
National Provider Identifier
1639583933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS13594
- Practice address
- 872 Executive Dr
Oviedo, FL 32765-7699 - Phone
- (407) 278-7089
- Fax
- (407) 777-4429
- NPI assigned
- Jun 13, 2014
- Last updated
- Aug 8, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS13594 | FL | Primary |
Addresses
Primary practice location
872 Executive Dr
Oviedo, FL 32765-7699
Mailing address
872 Executive Dr
Oviedo, FL 32765-7699
Phone (404) 278-7089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 14, 2022 through Jan 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS13594 | FL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659916800000",
"number": "1639583933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "872 EXECUTIVE DR",
"city": "OVIEDO",
"state": "FL",
"postal_code": "327657699",
"telephone_number": "404-278-7089",
"fax_number": "407-777-4429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "872 EXECUTIVE DR",
"city": "OVIEDO",
"state": "FL",
"postal_code": "327657699",
"telephone_number": "407-278-7089",
"fax_number": "407-777-4429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAHNKE",
"first_name": "BRADLEY",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-13",
"last_updated": "2022-08-08",
"certification_date": "2022-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS13594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oviedo, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.