Michael Bradley Clay, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026792 Issued in IL

Practice address

108 N 14TH St
Murphysboro, IL 62966-2008

Phone

(618) 684-6461

NPI assigned

Apr 23, 2007

Last updated

Jul 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1780802983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N 14TH ST",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629662008",
            "telephone_number": "618-684-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N 14TH ST",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629662008",
            "telephone_number": "618-684-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAY",
        "first_name": "MICHAEL",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Ann Cannell, LCPC
• Care Trak International Inc
• Joshua David Chady, PHARMD
• Christina L Chancey
• Nathan L Chapman, D.M.D.
• Elizabeth Charles Coelho, PT
• Comm Unit School Dist 186
• Comm Unit School Dist 186
• Comm Unit School District 186
• Comm Unit School District 186

• General Practice Dentistry in Murphysboro, IL
• Providers in Murphysboro, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.