Active NPI
Bradley Fernando Willmore
- Licensed Practical Nurse
- Euclid, OH
National Provider Identifier
1720371156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN-086367
- Practice address
- 312 E 215TH St
Euclid, OH 44123-1944 - Phone
- (216) 213-8926
- NPI assigned
- May 18, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN-086367 | OH | Primary |
Addresses
Primary practice location
312 E 215TH St
Euclid, OH 44123-1944
Mailing address
312 E 215TH St
Euclid, OH 44123-1944
Phone (216) 213-8926
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN-086367 | OH | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Assured Enterprises Incorporated | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Euclid, OH
- NPI 1023301462
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305676800000",
"number": "1720371156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 E 215TH ST",
"city": "EUCLID",
"state": "OH",
"postal_code": "441231944",
"telephone_number": "216-213-8926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 E 215TH ST",
"city": "EUCLID",
"state": "OH",
"postal_code": "441231944",
"telephone_number": "216-213-8926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLMORE",
"first_name": "BRADLEY",
"middle_name": "FERNANDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-18",
"last_updated": "2011-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN-086367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Euclid, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.