Active NPI
Jay A. Bradley, LAT, ATC
- Athletic Trainer
- Indianapolis, IN
National Provider Identifier
1871622589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36000217A
- Practice address
- 901 W New York St
Indianapolis, IN 46202-5224 - Phone
- (317) 274-0617
- Fax
- (317) 278-2041
- NPI assigned
- Mar 6, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36000217A | IN | Primary |
Addresses
Primary practice location
901 W New York St
Indianapolis, IN 46202-5224
Mailing address
5433 Cotton Bay Dr W
Indianapolis, IN 46254-4525
Phone (317) 299-6650
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36000217A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871622589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5433 COTTON BAY DR W",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462544525",
"telephone_number": "317-299-6650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 W NEW YORK ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025224",
"telephone_number": "317-274-0617",
"fax_number": "317-278-2041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "JAY",
"middle_name": "A.",
"name_prefix": "Mr.",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36000217A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.