Bradley Pierce Mudge, MD
Individual provider Active NPI Plastic Surgery Physician · Newport Beach, CA
NPI 1891764700 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1891764700
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Plastic Surgery Physician 208200000X
- License
- A79221 (CA)
- Practice address
- 240 Newport Center Drive
Suite 105
Newport Beach, CA 92660-7538 - Phone
- (949) 644-2450
- Fax
- (949) 644-2451
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Plastic and Reconstructive Surgery
- Education
- Loma Linda University School of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pacific Dermatology Institute
Practice addresses (Care Compare)
770 Magnolia Ave
Suite 1H
Corona, CA 92879-3121
Phone (951) 354-2220
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 31 |
| Removal of skin lesions | 13 |
| Removal of skin cancer | 411 |
| Removal of nail tissue | 1-10 |
| Skin biopsy | 17 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031106000436 | CA | Practitioner - Plastic and Reconstructive Surgery |
5890608806 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles (5 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Dermatology Institute | Dermatology | Current | Accepting new patients |
| 24 Hour Urgent Care of the Desert | Past |
Accepting new patients | |
| Pacific Medical Associates, Inc. | Past |
Accepting new patients | |
| Orange Coast Surgical Center, Inc | Past |
Accepting new patients | |
| Advanced Dermatology & Cosmetics Laser Care a Medical Corporation | Dermatology | Past | Accepting new patients |
Locations
240 Newport Center Dr
Ste 105
Newport Beach, CA 92660
Phone (951) 354-2220
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | A79221 | CA | |
| Surgery of the Hand (Plastic Surgery) Physician | 2082S0105X | A79221 | CA | |
| Plastic Surgery Physician | 208200000X | A79221 | CA | Yes |
Addresses
Primary practice location
240 Newport Center Drive
Suite 105
Newport Beach, CA 92660-7538
Mailing address
240 Newport Center Dr
#105
Newport Beach, CA 92660-7512
Phone (949) 644-2450
Other providers in Newport Beach, CA
- Mr Electrolysis Oc
- MRR Management, LLC
- Marady Msiri
- Mubina Gaffar MD Inc
- Grace Anne Mucci
- Prabhjot Pavan Mudhar
- Ram Mudiyam
- Cornelia Muehlhauser
- Hooriya Muhammad
- Jason Sean Muir
All providers in Newport Beach, CA · Plastic Surgery Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.