Ryan Bradley, PA-C
Individual provider Active NPI Physician Assistant · Globe, AZ
NPI 1790154664 · NPPES record last updated Sep 21, 2015
Key facts
- NPI
- 1790154664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1128591 (AZ)
- Practice address
- 5880 N Hospital Dr
Globe, AZ 85501 - Phone
- (928) 425-3247
- NPI assigned
- Sep 21, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- At Still University, Arizona School of Dentistry & Oral HLTH, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Alevea Mental Health LLC
Practice addresses (Care Compare)
2034 E Southern Ave
Suite D
Tempe, AZ 85282-7511
Phone (480) 779-8319
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151104000686 | AZ | Practitioner - Physician Assistant | 5294043527 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1128591 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cobre Valley Regional Medical Center | Current |
Accepting new patients | |
| Cobre Valley Regional Medical Center | Current |
Accepting new patients |
Locations
5994 S Hospital Dr
Globe, AZ 85501
Phone (928) 425-7108
5880 S Hospital Dr
Globe, AZ 85501
Phone (928) 402-1217
5882 S Hospital Dr
Ste 1
Globe, AZ 85501
Phone (928) 425-2474
5886 S Hospital Dr
Globe, AZ 85501
Phone (602) 507-6002
1134 W US Highway 60
Superior, AZ 85173
Phone (520) 689-2423
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1128591 | AZ | Yes |
Addresses
Primary practice location
5880 N Hospital Dr
Globe, AZ 85501
Mailing address
5880 N Hospital Dr
Globe, AZ 85501
Other providers in Globe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.