Active NPI
Bradley Darrell Faglie, M.D.
- Family Medicine Physician
- Decatur, TX
National Provider Identifier
1841443264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- N5045
- Practice address
- 1001 W Eagle Dr
Decatur, TX 76234-3745 - Phone
- (940) 627-7443
- Fax
- (940) 627-7597
- NPI assigned
- Oct 29, 2008
- Last updated
- Sep 22, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | N5045 | TX | Primary |
| Pediatrics Physician | 208000000X | N5045 | TX |
Addresses
Primary practice location
1001 W Eagle Dr
Decatur, TX 76234-3745
Mailing address
1001 W Eagle Dr
Decatur, TX 76234-3745
Phone (940) 627-7443
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00964976 | Other | TX | RAILROAD MEDICARE |
| 220200401 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 12, 2024 through Jul 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N5045 | TX | MD | Pediatrics Physician |
Interoperability endpoints
- bradley.faglie@4668404203524.direct.elationemr.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474502400000",
"number": "1841443264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 W EAGLE DR",
"city": "DECATUR",
"state": "TX",
"postal_code": "762343745",
"telephone_number": "940-627-7443",
"fax_number": "940-627-7464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W EAGLE DR",
"city": "DECATUR",
"state": "TX",
"postal_code": "762343745",
"telephone_number": "940-627-7443",
"fax_number": "940-627-7597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGLIE",
"first_name": "BRADLEY",
"middle_name": "DARRELL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-29",
"last_updated": "2016-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "N5045",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "N5045",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00964976",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "220200401",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.