Bradley Glen Doll, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAC0942 Issued in ND

Practice address

4920 S 30TH St Ste 103
Omaha, NE 68107-1656

Phone

(402) 734-4110

Fax

(402) 734-3990

NPI assigned

Oct 2, 2017

Last updated

May 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AK, TX, MN3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Norton Sound Regional Hospital Hospital, Nome, AK, CCN 021308

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Aleknagik North, AK
  • NPI 1235291246

  TX

  Medicare reassignment NPD
• Norton Sound Health Corporation

  • Critical Access Hospital
  • Nome, AK
  • NPI 1154358232

  Physician Assistant

  Medicare reassignment NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Koliganek, AK
  • NPI 1013079607
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Ekwok, AK
  • NPI 1104988799
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Pilot Point, AK
  • NPI 1174683825
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Platinum, AK
  • NPI 1285796870
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Levelock, AK
  • NPI 1366502767
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Twin Hills, AK
  • NPI 1487716825
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Perryville, AK
  • NPI 1528128782
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Chignik Lagoon, AK
  • NPI 1578623641
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Egegik, AK
  • NPI 1699836007
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • New Stuyahok, AK
  • NPI 1720148976
  NPD

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

• Norton Sound Health Corporation

  • Critical Access Hospital
  • Nome, AK
  • NPI 1225101041
  Care Compare affiliation

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

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1720598972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4920 S 30TH ST STE 103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071656",
            "telephone_number": "402-734-4110",
            "fax_number": "402-734-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 S 30TH ST STE 103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071656",
            "telephone_number": "402-734-4110",
            "fax_number": "402-734-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLL",
        "first_name": "BRADLEY",
        "middle_name": "GLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-02",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0942",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "2172",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Doland
• Mary Doland
• Lauren Rae Dole, OD
• Laura Dolejs, LCSW
• Kandice E Dolesh, PA-C
• Heather Danielle Doll, PLMHP
• Kelli Sue Doll, APRN
• Thomas J Dollison, CRNA
• Yvette Dollison
• Tamara A Dolphens, PA

• Physician Assistant in Omaha, NE
• Providers in Omaha, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.