Bradley Anthony Qualizza, PA

Key facts

NPI

1962996637

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

10002518A (IN)

Practice address

85 E US Highway 6
Valparaiso, IN 46383-8947

Phone

(219) 983-8300

NPI assigned

Jun 18, 2018

Sex

Male

Sole proprietor

No

Organizations & group practices 5

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.

• Urgent Care Solutions Glendale, P.C. Urgent Care Clinic/Center · Denver, CO · NPI 1336491075
  Medicare reassignment Care Compare group NPD CO
• Primary Care Solutions P.C. Primary Care Clinic/Center · Denver, CO · NPI 1871923250
  Medicare reassignment CO
• Urgent Care Solutions, Glendale, PC Urgent Care Clinic/Center · Denver, CO · NPI 1184099418
  NPD
• Primary Care Solutions P.C. Primary Care Clinic/Center · Denver, CO · NPI 1386527091
  NPD (past)
• Primary Care Solutions P.C. Primary Care Clinic/Center · Denver, CO · NPI 1851274567
  NPD (past)

Medicare Care Compare profile

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgent Care Solutions Glendale PC (42 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 28, 2018.

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1962996637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 E US HIGHWAY 6",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463838947",
            "telephone_number": "219-983-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALIZZA",
        "first_name": "BRADLEY",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002518A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Valparaiso, IN · Physician Assistant in Indiana