NPIMap

Organization Active NPI

Bradley Bibb MD PLLC

  • Family Medicine Physician
  • Bay, AR
National Provider Identifier
1871968388
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E4136 Issued in AR
Legal business name
BRADLEY BIBB MD PLLC
Practice address
201 S Bay Dr
Bay, AR 72411
Phone
(870) 770-1920
Fax
(870) 994-7488
NPI assigned
Dec 9, 2015
Last updated
Feb 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Authorized official

Name
Bradley Bibb, M.D.NPI 1700824307
Title
Owner
Phone
(870) 994-7301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X E4136 AR Primary

Addresses

Primary practice location

201 S Bay Dr
Bay, AR 72411

Mailing address

49 Highway 62 412
Ash Flat, AR 72513-9594

Other practice location 1

201 south bay drive
bay, AR 72411
Phone (870) 994-7301

Other practice location 2

201 south bay drive
bay, AR 72411
Phone (870) 994-7301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100628000488 AR Part B Supplier - Clinic/Group Practice 4789715285 Receives reassigned benefits from 95 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ash Flat, AR; Black Rock, AR; Bono, AR; Dardanelle, AR; Hardy, AR; Marked Tree, AR; Salem, AR; Texarkana, AR

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

201 S Bay Dr
Bay, AR 72411
Phone (870) 770-1920

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1871968388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 HIGHWAY 62 412",
            "city": "ASH FLAT",
            "state": "AR",
            "postal_code": "725139594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S BAY DR",
            "city": "BAY",
            "state": "AR",
            "postal_code": "72411",
            "telephone_number": "870-770-1920",
            "fax_number": "870-994-7488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 south bay drive",
            "address_purpose": "LOCATION",
            "city": "bay",
            "state": "AR",
            "postal_code": "72411",
            "country_code": "US",
            "telephone_number": "870-994-7301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 south bay drive",
            "address_purpose": "LOCATION",
            "city": "bay",
            "state": "AR",
            "postal_code": "72411",
            "country_code": "US",
            "telephone_number": "870-994-7301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRADLEY BIBB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "BIBB",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-994-7301",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E4136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.