NPIMap

Organization Active NPI

The Bradley Clinic of Texas, PLLC

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1881069557
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L1276 Issued in TX
Legal business name
THE BRADLEY CLINIC OF TEXAS, PLLC
Practice address
1402 Rice Rd
Suite 100
Tyler, TX 75703-3260
Phone
(903) 630-7691
NPI assigned
Dec 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Authorized official

Name
Dale J Bradley, D.O.NPI 1588607428
Title
President
Phone
(903) 630-7691

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X L1276 TX Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

1402 Rice Rd
Suite 100
Tyler, TX 75703-3260

Mailing address

1402 Rice Rd Ste 100
Tyler, TX 75703-3230
Phone (903) 630-7691

Other identifiers 1

IdentifierTypeStateIssuer
365965801MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160310000191 TX Part B Supplier - Clinic/Group Practice 3577869015 Receives reassigned benefits from 5 practitioners
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

1402 Rice Rd
Ste 100
Tyler, TX 75703
Phone (903) 630-7691

1402 Rice Rd
Tyler, TX 75703

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1881069557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 RICE RD STE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033230",
            "telephone_number": "903-630-7691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 RICE RD",
            "address_2": "SUITE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033260",
            "telephone_number": "903-630-7691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BRADLEY CLINIC OF TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-630-7691",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L1276",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "365965801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; 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.