Active NPI
Bradley Havelka, ED.S.
- Specialist
- Mentor, OH
National Provider Identifier
1720488497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OH3175620
- Practice address
- 6477 Center St
Mentor, OH 44060-4109 - Phone
- (440) 974-5332
- NPI assigned
- Aug 29, 2014
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | OH3175620 | OH | Primary |
Addresses
Primary practice location
6477 Center St
Mentor, OH 44060-4109
Mailing address
6477 Center St
Mentor, OH 44060-4109
Phone (440) 974-5332
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 |
|---|---|---|---|
| OH3175620 | OH | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Epicenter ABA, LLC | 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.
-
- Behavior Analyst
- Solon, OH
- NPI 1396252599
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409270400000",
"number": "1720488497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6477 CENTER ST",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604109",
"telephone_number": "440-974-5332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6477 CENTER ST",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604109",
"telephone_number": "440-974-5332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVELKA",
"first_name": "BRADLEY",
"credential": "ED.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-29",
"last_updated": "2014-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OH",
"license": "OH3175620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mentor, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.