Jesse G Bradshaw, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1467 Issued in ID

Practice address

1252 Bennett Ave Ste B
Burley, ID 83318-2664

Phone

(208) 647-0656

NPI assigned

Aug 24, 2018

Last updated

Dec 13, 2018By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Physicians Immediate Care of Twin Falls PAGroup PAC ID 0143460717, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cassia Regional Hospital Hospital, Burley, ID, CCN 131326

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: jesse.bradshaw.1@29843.direct.athenahealth.com

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.

• Physicians Immediate Care of Twin Falls PA

  dba Physicians Immediate Care Center

  • Urgent Care Clinic/Center
  • Twin Falls, ID
  • NPI 1114141090
  Medicare reassignment Care Compare group

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

• Ihc Health Services, Inc.

  dba Intermountain Health Cassia Regional Hospital

  • General Acute Care Hospital
  • Burley, ID
  • NPI 1497865315
  Care Compare affiliation

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

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544659200000",
    "number": "1821579012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 CHENEY DR W STE 200",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014278",
            "telephone_number": "208-647-0656",
            "fax_number": "208-647-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1252 BENNETT AVE STE B",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182664",
            "telephone_number": "208-647-0656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "JESSE",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-24",
        "last_updated": "2018-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA1467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven L Borden, PHARM D
• Gina Bosco, LCSW
• Mathew G Bowden, CSW
• Amanda Bowen
• Rand N. Bracken, CRNA
• Daniel Joseph Brauner, O.D.
• Bright Beginnings Counseling
• Duane Broderick
• Nelson S Browning, DO
• Bryce W Millar MD, PLLC

• Physician Assistant in Burley, ID
• Providers in Burley, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2018; 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.