Active NPI
John Melvin Brady, MD
- Internal Medicine Physician
- Bossier City, LA
National Provider Identifier
1669404851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 013084
- Practice address
- 2400 Hospital Dr
Suite 420
Bossier City, LA 71111-2385 - Phone
- (318) 212-7910
- Fax
- (318) 752-7915
- NPI assigned
- Jul 7, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 013084 | LA | Primary |
Addresses
Primary practice location
2400 Hospital Dr
Suite 420
Bossier City, LA 71111-2385
Mailing address
2400 Hospital Dr
Suite 420
Bossier City, LA 71111-2385
Phone (318) 212-7910
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1311341 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170302001730 | AR | Practitioner - Internal Medicine | 9638269236 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13084 | LA | MD | Clinical Social Worker |
| 013084 | LA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199318400000",
"number": "1669404851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 HOSPITAL DR",
"address_2": "SUITE 420",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711112385",
"telephone_number": "318-212-7910",
"fax_number": "318-752-7915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 HOSPITAL DR",
"address_2": "SUITE 420",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711112385",
"telephone_number": "318-212-7910",
"fax_number": "318-752-7915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADY",
"first_name": "JOHN",
"middle_name": "MELVIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2008-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "LA",
"license": "013084",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1311341",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.