NPIMap

Individual provider Active NPI

Bradley J Scott, MD

  • Family Medicine Physician
  • Granger, IN
National Provider Identifier
1720078835
Registry record updated Jul 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01044001A Issued in IN
Practice address
52500 Fir Rd
Granger, IN 46530-8579
Phone
(574) 271-0700
Fax
(574) 273-5648
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01044001A IN Primary

Addresses

Primary practice location

52500 Fir Rd
Granger, IN 46530-8579

Mailing address

52500 Fir Rd
Granger, IN 46530-8579
Phone (574) 271-0700

Other identifiers 1

IdentifierTypeStateIssuer
200025910MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20091210000377 IN Practitioner - Family Practice 3870680739 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

Practice addresses (Care Compare)

211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 234-8161

301 E Day Rd
Mishawaka, IN 46545-3455
Phone (574) 204-6700

52500 Fir Rd
Granger, IN 46530-8579
Phone (574) 271-0700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01044001AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The South Bend Clinic, LLC CurrentSince Dec 1, 1999 Accepting new patients
The South Bend Clinic LLC CurrentSince Dec 1, 1999 Accepting new patients

Locations

52500 Fir Rd
Granger, IN 46530
Phone (574) 204-7050

211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331

Interoperability endpoints

  • Direct secure messaging: bscott255113@dulyhealthandcare.direct-ci.com
  • FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/

Organizations & group practices 2

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.

Hospital & facility affiliations 12

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": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469750400000",
    "number": "1720078835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52500 FIR RD",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308579",
            "telephone_number": "574-271-0700",
            "fax_number": "574-273-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52500 FIR RD",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308579",
            "telephone_number": "574-271-0700",
            "fax_number": "574-273-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2016-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01044001A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200025910",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Granger, IN

Sources for this page

Verify at the official NPI Registry.