Active NPI
John Edward Bradford, PA-C
- Physician Assistant
- Anchorage, AK
National Provider Identifier
1720004740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA732
- Practice address
- 701 Tudor Dr
Ste 110
Anchorage, AK 99503 - Phone
- (907) 685-1420
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25769 | MT | |
| Physician Assistant | 363A00000X | PADA1193 | AK | |
| Physician Assistant | 363A00000X | PA732 | WY | Primary |
Addresses
Primary practice location
701 Tudor Dr
Ste 110
Anchorage, AK 99503
Mailing address
PO Box 58
Yellowstone National Park, WY 82190-0058
Phone (307) 344-7965
Other practice location 1
108 Albright Ave #58
Ynp, WY 82190
Phone (307) 344-7965
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY, MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100916000553 | WY | Practitioner - Physician Assistant | 9234254087 | Reassigns benefits to 1 organization |
| I20170921002023 | MT | Practitioner - Physician Assistant | 9234254087 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Stgi Health, LLC
Practice addresses (Care Compare)
2126 Opal Ave
Yellowstone National Park, WY 82190
Phone (703) 578-6030
Old Faithful Clinic 122 Clinic LN
Yellowstone National Park, WY 82190
Phone (703) 578-6030
Hospital & facility affiliations
- Billings Clinic Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PADA1193 | AK | MD | Physician Assistant |
| 25769 | MT | MD | Physician Assistant |
| PA732 | WY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Montana Clinic PC | Current | Accepting new patients | |
| Medcor of Barrington, P.C. | Current | Accepting new patients | |
| Raymond E. Andreassen | Past | Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients | |
| Tok Clinic, LLC | Past | Accepting new patients |
Locations
500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918
Interoperability endpoints
- stgihealthllc.johnebradford@154263.advancedmd-direct.com
Organizations & group practices 7
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Family Medicine Physician
- McHenry, IL
- NPI 1225122344
-
- Family Medicine Physician
- Delta Junction, AK
- NPI 1366640070
-
- Family Medicine Physician
- Tok, AK
- NPI 1043417959
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
Hospital & facility affiliations 8
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": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672790400000",
"number": "1720004740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 58",
"city": "YELLOWSTONE NATIONAL PARK",
"state": "WY",
"postal_code": "821900058",
"telephone_number": "307-344-7965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 TUDOR DR",
"address_2": "STE 110",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "99503",
"telephone_number": "907-685-1420"
}
],
"practiceLocations": [
{
"address_1": "108 Albright Ave #58",
"address_purpose": "LOCATION",
"city": "YNP",
"state": "WY",
"postal_code": "82190",
"country_code": "US",
"telephone_number": "307-344-7965",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRADFORD",
"first_name": "JOHN",
"middle_name": "EDWARD",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2023-01-04",
"certification_date": "2023-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MT",
"license": "25769",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AK",
"license": "PADA1193",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WY",
"license": "PA732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.