Active NPI
V Jean Bradley, NP
- Adult Health Nurse Practitioner
- Fort Wayne, IN
National Provider Identifier
1770535668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 71001398
- Practice address
- 7910 W Jefferson Blvd
Suite 300
Fort Wayne, IN 46804-4159 - Phone
- (260) 432-1800
- Fax
- (260) 432-1804
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 71001398 | IN | Primary |
Addresses
Primary practice location
7910 W Jefferson Blvd
Suite 300
Fort Wayne, IN 46804-4159
Mailing address
7910 W Jefferson Blvd
Suite 300
Fort Wayne, IN 46804-4159
Phone (260) 432-1800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200406350 | Medicaid | IN |
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)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana Medical Associates, LLC | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Physical Medicine Consultants LLC | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/1725/brand/1/csg/1/fhir/r4
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- Fort Wayne, IN
- NPI 1780628545
-
- Physical Medicine & Rehabilitation Physician
- Fort Wayne, IN
- NPI 1447314067
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288915200000",
"number": "1770535668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7910 W JEFFERSON BLVD",
"address_2": "SUITE 300",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044159",
"telephone_number": "260-432-1800",
"fax_number": "260-432-1804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7910 W JEFFERSON BLVD",
"address_2": "SUITE 300",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044159",
"telephone_number": "260-432-1800",
"fax_number": "260-432-1804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "V",
"middle_name": "JEAN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-17",
"last_updated": "2010-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "IN",
"license": "71001398",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200406350",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.