NPIMap

Individual provider Active NPI

David R Bradshaw

  • Orthotic Fitter
  • Union Grove, NC
National Provider Identifier
1740517937
Registry record updated Nov 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthotic FitterTaxonomy code 225000000X
Practice address
1892 West Memorial Hwy.
Union Grove, NC 28689-9049
Phone
(704) 539-4445
Fax
(704) 539-4663
NPI assigned
Nov 9, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthotic Fitter 225000000X Primary

Addresses

Primary practice location

1892 West Memorial Hwy.
Union Grove, NC 28689-9049

Mailing address

P.O. Box 103
Union Grove, NC 28689-0103
Phone (704) 539-4445

Other identifiers 1

IdentifierTypeStateIssuer
7703861MedicaidNC

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

Practice roles

OrganizationSpecialtyStatusNew patients
National Med Source LLC Past Accepting new patients
National Med Source Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1257724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257724800000",
    "number": "1740517937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 103",
            "city": "UNION GROVE",
            "state": "NC",
            "postal_code": "286890103",
            "telephone_number": "704-539-4445",
            "fax_number": "704-539-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1892 WEST MEMORIAL HWY.",
            "city": "UNION GROVE",
            "state": "NC",
            "postal_code": "286899049",
            "telephone_number": "704-539-4445",
            "fax_number": "704-539-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "DAVID",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-09",
        "last_updated": "2009-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7703861",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Union Grove, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.