Bradley James Petty, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

MD60907536 Issued in WA

Practice address

780 Swift Blvd Ste 301
Richland, WA 99352-3524

Phone

(509) 942-3178

Fax

(509) 946-1735

NPI assigned

Apr 3, 2014

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

Georgetown University School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kadlec Regional Medical CenterGroup PAC ID 9739098617, 402 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kadlec Regional Medical Center Hospital, Richland, WA, CCN 500058
• Trios Health Hospital, Kennewick, WA, CCN 500053

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  Medicare reassignment Care Compare group NPD
• Kadlec Regional Medical Center

  • Orthopaedic Surgery Physician
  • Richland, WA
  • NPI 1194263608
  NPD
• Kadlec Regional Medical Center

  • Rehabilitation Hospital Unit
  • Richland, WA
  • NPI 1790319580
  NPD

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

• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  Care Compare affiliation
• RCCH Trios Health LLC

  • General Acute Care Hospital
  • Kennewick, WA
  • NPI 1578058137
  Care Compare affiliation

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1790103976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 GAGE BLVD STE 101",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993529532",
            "telephone_number": "509-942-3627",
            "fax_number": "509-627-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 SWIFT BLVD STE 301",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993523524",
            "telephone_number": "509-942-3178",
            "fax_number": "509-946-1735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "910 Madison Ave Ste 1031",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033403",
            "country_code": "US",
            "telephone_number": "901-448-5364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTY",
        "first_name": "BRADLEY",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD60907536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpetty1109605@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "780 Swift Blvd Ste 301",
            "city": "Richland",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993523524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Scott Peterson, PTA
• Pamela Peterson, RN
• Peggy Ann Peterson, MA
• Susan Lynne Peterson, R.N.
• Katherine Pettijohn, LMHCA
• Phat P Pham, MD
• Thienan Nguyen Pham, PHARMD
• Amanda Pharris
• Nicole Pheifer, SLP
• David James Pheysey, M.D.

• Otolaryngology Physician in Richland, WA
• Providers in Richland, WA by specialty
• Otolaryngology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.