Brady Benjamin Elliott, CPED, CFO

Primary specialty

PedorthistTaxonomy code 224L00000X

Practice address

5923 Clark Rd
Ste C
Paradise, CA 95969

Phone

(530) 872-3710

Fax

(530) 872-7234

NPI assigned

Sep 22, 2010

Last updated

Dec 8, 2014By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• 2ND Sole-Custom Shoes & Orthotics, Inc

  • Customized Equipment (DME)
  • Paradise, CA
  • NPI 1841321403
  NPD (past) Authorized official

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417996800000",
    "number": "1790093987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5923 CLARK RD",
            "address_2": "STE C",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "95969",
            "telephone_number": "530-872-3710",
            "fax_number": "530-872-7234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5923 CLARK RD",
            "address_2": "STE C",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "95969",
            "telephone_number": "530-872-3710",
            "fax_number": "530-872-7234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "BRADY",
        "middle_name": "BENJAMIN",
        "name_prefix": "Mr.",
        "credential": "CPED, CFO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-22",
        "last_updated": "2014-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas L. Edgar, P.A.
• Lori Eiler, LCSW
• Brian John Eisermann
• Elite Biomechanical Design
• Sherilyn Deann Elkins, MSMFTI
• Michael James Ellis, DPT
• Timothy S Elloway, D.D.S.
• Samer Elsalman
• Renee Elsen
• Ember Care Corporation (Cypress Acres Convalescent Hospital)

• Pedorthist in Paradise, CA
• Providers in Paradise, CA by specialty
• Pedorthist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.

Verify at the official NPI Registry.