NPIMap

Individual provider Active NPI

Bradley Deane Noblett, MD

  • Neurological Surgery Physician
  • Orange, CA
National Provider Identifier
1689788507
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
G86364 Issued in CA
Practice address
1010 West la Veta Ave
Suite 710
Orange, CA 92868
Phone
(714) 835-2724
Fax
(714) 835-2751
NPI assigned
Aug 18, 2006
Last updated
May 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X G86364 CA Primary

Addresses

Primary practice location

1010 West la Veta Ave
Suite 710
Orange, CA 92868

Mailing address

1010 West la Veta Ave
Suite 710
Orange, CA 92868
Phone (714) 835-2724

Other practice location 1

100 E Valencia Mesa Dr Ste 310
Fullerton, CA 92835-3800
Phone (714) 734-3120

Other identifiers 1

IdentifierTypeStateIssuer
00G863640MedicaidCA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bnoblett1372764@oc.providencedirect.org
Direct Messaging Address bnoblett1372764@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20050715000641 CA Practitioner - Neurosurgery 0143256636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Utah School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

100 E Valencia Mesa Dr
Suite 105
Fullerton, CA 92835-3816
Phone (714) 871-3006

1100 W Stewart Dr
Orange, CA 92868-3849
Phone (714) 633-9111

1140 W la Veta Ave
Suite 770
Orange, CA 92868-4229
Phone (714) 835-8715

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

2501 E Chapman Ave
Orange, CA 92869-3204
Phone (714) 633-7175

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion63
Laminectomy or laminotomy (partial removal of spine bones)14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G86364CAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Jun 1, 2014 Accepting new patients
Providence Medical Foundation CurrentSince Jun 1, 2014 Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Kingman Healthcare, Inc Past Accepting new patients
Flagstaff Medical Center Past Accepting new patients
University of California Irvine Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

100 E Valencia Mesa Dr
Ste 310
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

1010 W La Veta Ave
Ste 710
Orange, CA 92868
Phone (714) 835-2724

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: bnoblett1372764@oc.providencedirect.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence St. Jude Medical CenterFullerton, CA, CCN 050168 Hospital Corporate Director Jan 1, 2025
Providence St. Jude Medical CenterFullerton, CA, CCN 05T168 Hospital Corporate Director Jan 1, 2025

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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 4

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1689788507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 WEST LA VETA AVE",
            "address_2": "SUITE 710",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "92868",
            "telephone_number": "714-835-2724",
            "fax_number": "714-835-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 WEST LA VETA AVE",
            "address_2": "SUITE 710",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "92868",
            "telephone_number": "714-835-2724",
            "fax_number": "714-835-2751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Valencia Mesa Dr Ste 310",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928353800",
            "country_code": "US",
            "telephone_number": "714-734-3120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOBLETT",
        "first_name": "BRADLEY",
        "middle_name": "DEANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "G86364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G863640",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bnoblett1372764@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "100 E Valencia Mesa Dr Ste 310",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928353800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bnoblett1372764@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "100 E Valencia Mesa Dr Ste 310",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928353800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.