Stephen Peter Bradley, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

C41489 Issued in CA

Practice address

5375 Lakeshore Blvd
Lakeport, CA 95453-6123

Phone

(707) 263-5679

Fax

(707) 263-7781

NPI assigned

Jan 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Adventist Health Clearlake Hospital Inc.

  • Critical Access Hospital
  • Clearlake, CA
  • NPI 1124018031

  Hospital

  Care Compare affiliation
• Sutter Bay Hospitals

  • Critical Access Hospital
  • Lakeport, CA
  • NPI 1952634008

  Hospital

  Care Compare affiliation
• Sutter Visiting Nurse Association and Hospice

  • Home Health Agency
  • Lakeport, CA
  • NPI 1871734244
  Care Compare affiliation
• Ukiah Adventist Hospital

  • General Acute Care Hospital
  • Ukiah, CA
  • NPI 1235120676

  Hospital

  Care Compare affiliation

Specialty

Family PracticeAlso: Addiction Medicine

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Care at Home Home health agency, Lakeport, CA, CCN 057620
• Sutter Lakeside Hospital Hospital, Lakeport, CA, CCN 051329
• Adventist Health Clearlake Hospital, Clearlake, CA, CCN 051317
• Adventist Health Ukiah Valley Hospital, Ukiah, CA, CCN 050301

Procedures performed for Medicare patients

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1699746446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5375 LAKESHORE BLVD",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536123",
            "telephone_number": "707-263-5679",
            "fax_number": "707-263-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5375 LAKESHORE BLVD",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536123",
            "telephone_number": "707-263-5679",
            "fax_number": "707-263-7781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "STEPHEN",
        "middle_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C41489",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "C41489",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CA",
            "license": "C41489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C414890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martyna Joanna Blissky
• Ellen Marie Boersma, NP
• Ronald J Botelho, M.D.
• Emmalena Ann Boyd, OD
• Kathleen Louise Bradley, P. T.
• David L. Browning, O.D.
• Mark Louis Buehnerkemper, O.D.
• Carleene Janice Cady, NP
• Liliana Caicedo, DDS
• California Pacific Pathology Medical Group

• All providers in Lakeport, CA
• Addiction Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.