Macon Samuel Bradley, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

03294 Issued in KY

Practice address

153 Dowell Rd
Russell Springs, KY 42642-4579

Phone

(270) 866-4141

NPI assigned

Jul 25, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in KY, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Emergency Medicine Services of Ky, LLC

  • Emergency Medicine Physician
  • Bowling Green, KY
  • NPI 1033816194

  Emergency Medicine, KY

  Medicare reassignment NPD
• Russell County Hospital

  • Certified Registered Nurse Anesthetist
  • Russell Springs, KY
  • NPI 1437245842

  KY

  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  Emergency Medicine, KY

  Medicare reassignment NPD
• App of Tennessee Ed, PLLC

  • Emergency Medicine Physician
  • Maryville, TN
  • NPI 1003230236

  Emergency Medicine, TN

  Medicare reassignment NPD
• Russell County Hospital

  • Rural Health Clinic/Center
  • Russell Springs, KY
  • NPI 1295245025
  NPD
• Russell County Hospital

  • Nurse Practitioner
  • Russell Springs, KY
  • NPI 1538255948

  Family Medicine

  NPD
• Tennessee Em-I Medical Services PC

  • Physician Assistant
  • Lebanon, TN
  • NPI 1164742300
  NPD (past)

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

{
    "created_epoch": "1248480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504137600000",
    "number": "1851521744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1610",
            "address_2": "DOWELL RD",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "42642",
            "telephone_number": "270-866-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 DOWELL RD",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426424579",
            "telephone_number": "270-866-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MACON",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-25",
        "last_updated": "2017-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "03294",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "KY",
            "license": "03294",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "03294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Lynn Bailey, M.ED., NCC, LPCC-S
• Rhonda Dawn Begley, LPCC, TCADC
• Robert L. Bertram, D.O.
• Barrett K Blakey, PHARM D
• Jana K Bowmer, LCSW
• Susan Bradshaw, APRN FNP
• Ashley Bragg, BCBA, LBA
• James Baxter Brown, PHARM.D.
• Shannon Lee Brown, FNP
• Angelia Shaw Bryant, NCC CCMHC CHT LPCC-S

• All providers in Russell Springs, KY
• Emergency Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2017; 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.