Jacklyn Bradley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

333 Budlong Rd
Cranston, RI 02920-6337

Phone

(401) 943-4530

NPI assigned

Jan 4, 2016

Sex

Female

Sole proprietor

No

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 RI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• HDC Care Solutions, LLC

  • Nurse Practitioner
  • Framingham, MA
  • NPI 1033861349

  RI

  Medicare reassignment NPD
• Healthdrive Medical Services Southeast LLC

  • Nurse Practitioner
  • Columbia, MD
  • NPI 1437930146

  RI

  Medicare reassignment NPD
• Medicine and Long Term Care Associates, LLC

  • Internal Medicine Physician
  • Cranston, RI
  • NPI 1073539227
  Medicare reassignment
• Medi Health and Wellness, LLC

  • Family Medicine Physician
  • Warwick, RI
  • NPI 1497253322
  NPD (past)
• MW Wellness Ventures II, LLC

  • Family Medicine Physician
  • Warwick, RI
  • NPI 1437651882
  NPD (past)

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

{
    "created_epoch": "1451865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451865600000",
    "number": "1790141976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 BUDLONG RD",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206337",
            "telephone_number": "401-943-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 BUDLONG RD",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206337",
            "telephone_number": "401-943-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "JACKLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-04",
        "last_updated": "2016-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vlad Botezatu, DMD
• Caitlin Bouchard, LMHC
• Joseph Bouchard, LMHC
• Kayla Bourbonniere
• Linda A. Boutilier, LICSW
• William M Bradley, LMT
• Amy Bragger, RN
• Michele Denise Branagan, NP-C
• Alexandra Rae Branca, LICSW
• Mark R Brancato, LICAC

• Physician Assistant in Cranston, RI
• Providers in Cranston, RI by specialty
• Physician Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.