Active NPI
Bradley Jackson
- Adult Companion
- Janesville, WI
National Provider Identifier
1831907393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 2921 Randolph Rd
Janesville, WI 53545-0665 - Phone
- (608) 866-0689
- NPI assigned
- Dec 30, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | Primary |
Addresses
Primary practice location
2921 Randolph Rd
Janesville, WI 53545-0665
Mailing address
4100 Wyndham Dr NE
Cedar Rapids, IA 52402-2565
Phone (608) 866-0689
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736208000000",
"number": "1831907393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 WYNDHAM DR NE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524022565",
"telephone_number": "608-866-0689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2921 RANDOLPH RD",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535450665",
"telephone_number": "608-866-0689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BRADLEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-30",
"last_updated": "2025-01-07",
"certification_date": "2025-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Janesville, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.