Look up the most recent NPI and PECOS records

Boden Bradley

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3005 Douglas Blvd Ste 105, Roseville, CA 95661-3885

PECOS Enrollment

Based on the most recent information from CMS, provider Boden Bradley is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1699229112
Provider Type
Individual
Full Name
Bradley, Boden
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
8/12/2016
Last Updated
6/15/2021

Contact Information

Practice Location

3005 Douglas Blvd Ste 105, Roseville, CA 95661-3885

(916) 742-7718

(510) 350-9190

Mailing Location

3005 Douglas Blvd Ste 105, Roseville, CA 95661-3885

(916) 742-7718

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 56390 California

Boden Bradley

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Mcdonald, Heather

Knox, Stephanie

Snarr, Matthew

Miranda, Lisa M

Samuels, Jason

Kaur, Manpreet

Bains, Roseanna Pauli

Nemolyaev, Sergey A.

Byrd, Asha Pavani

Peres, Steven E