Brian Bradway, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

12332 Issued in MN

Practice address

1835 County Road C W Ste 150
Roseville, MN 55113

Phone

(763) 581-0340

Fax

(763) 581-0341

NPI assigned

Jan 12, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bbradway127920@direct.northmemorial.com

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.

• North Memorial Health Care

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Medicare reassignment NPD
• Student Health Service University of St. Thomas

  • Student Health Clinic/Center
  • Saint Paul, MN
  • NPI 1881819886
  NPD (past)

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

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532304000000",
    "number": "1992241095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 COUNTY ROAD C W STE 150",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131343",
            "telephone_number": "763-581-0340",
            "fax_number": "763-581-0341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 COUNTY ROAD C W STE 150",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "763-581-0340",
            "fax_number": "763-581-0341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADWAY",
        "first_name": "BRIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-12",
        "last_updated": "2018-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12332",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "12332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BPK Professionals, LLC
• Jeffrey Rex Brace, M.D.
• Jessica Lynn Bracken, BCBA
• Carissa Kay Bradley
• Kevin E Bradt, LADC
• Brain Injury Association of Minnesota
• Braincare, LLC
• Michael Anthony Branchaud, LPC
• Breakthrough Medical Supply Inc
• Grant Tyler Brekken, CRNA

• Medical Physician Assistant in Roseville, MN
• Providers in Roseville, MN by specialty
• Medical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.