Nicole Bradway
Individual provider Active NPI Physician Assistant · Royal Oak, MI
NPI 1639698236 · NPPES record last updated May 19, 2026
Key facts
- NPI
- 1639698236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601010351 (MI)
- Practice address
- 30575 Woodward Ave
Royal Oak, MI 48073-0980 - Phone
- (248) 280-8550
- Fax
- (844) 266-0093
- NPI assigned
- Sep 14, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 16
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Mercy College, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- White Plains Physician Services PC
Michigan Orthopaedic Surgeons PLLC
Fairway Physical Therapy LLC
Practice addresses (Care Compare)
122 Maple Ave
White Plains, NY 10601-4706
Phone (914) 285-9808
185 Kisco Ave
Suite 300
Mount Kisco, NY 10549-1409
Phone (914) 242-2020
30575 Woodward Ave
Royal Oak, MI 48073-0980
Phone (248) 280-8550
7100 Fairway Dr
Palm Beach Gardens, FL 33418-3778
Phone (561) 775-7775
Hospital & facility affiliations
- White Plains Hospital Center
- Burke Rehabilitation Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 99.15 of 100
- Promoting interoperability
- 99
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.22 of 100
- Quality
- 82.55
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 64.86
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171107000468 | NY | Practitioner - Physician Assistant | 3476819517 | Reassigns benefits to 1 organization |
| I20260513000433 | MI | Practitioner - Physician Assistant | 3476819517 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6168 | CT | MD | Professional Counselor |
| 5601010351 | MI | MD | Physician Assistant |
Practice roles (5 of 9)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan Orthopaedic Surgeons, PLLC | Current |
Accepting new patients | |
| Michigan Orthopaedic Surgeons PLLC | Current |
Accepting new patients | |
| White Plains Physician Services PC | Current |
Accepting new patients | |
| Orthopaedic & Neurosurgery Specialists, PLLC | Physician Assistant | Current |
Accepting new patients |
| VHS Physicians of Michigan | Past |
Accepting new patients |
Locations
6 Greenwich Office Park
#40
Greenwich, CT 06831
Phone (203) 869-1145
6 Greenwich Office Park
Greenwich, CT 06831
Phone (203) 869-1145
45816 Schoenherr Rd
Utica, MI 48315
Phone (586) 842-2400
99 Business Park Dr
Armonk, NY 10504
Phone (914) 219-8515
185 Kisco Ave
Ste 300
Mount Kisco, NY 10549
Phone (914) 242-2020
160 N Midland Ave
Nyack, NY 10960
Phone (845) 348-2000
1133 Westchester Ave
White Plains, NY 10604
Phone (914) 358-9700
122 Maple Ave
Fl 8
White Plains, NY 10601
Phone (914) 849-5300
41 E Post Rd
White Plains, NY 10601
Phone (914) 681-1201
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
Interoperability endpoints
- nshelly@ons.emadirect.md
- nicole.bradway.1@9974.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | |||
| Physician Assistant | 363A00000X | 5601010351 | MI | Yes |
Addresses
Primary practice location
30575 Woodward Ave
Royal Oak, MI 48073-0980
Mailing address
PO Box 18998
Belfast, ME 04915-4084
Phone (469) 803-3000
Other practice location 1
3901 Beaubien St Ste 1
Detroit, MI 48201-2119
Phone (313) 745-5227
Other practice location 2
45816 Schoenherr Rd
Shelby Twp, MI 48315-6028
Phone (586) 842-2400
Other names
- Nicole Shelly
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nicole.bradway.1@9974.direct.athenahealth.com | Direct |
Other providers in Royal Oak, MI
- Katharine E Brace
- Olivia Jane Brack
- Olivia Bradin
- Anthony Bradley
- Mikaela Bradley
- Pavan Brahmamdam
- Alyssa Brandenburg
- Shawn Brandenburg
- Nathan James Branson
- Patricia A. Braski
All providers in Royal Oak, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.