MR. BRADY BENJAMIN ELLIOTT (NPI# 1790093987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1790093987 |
Entity Type | Individual |
Full Name | MR. BRADY BENJAMIN ELLIOTT |
Credential | CPED, CFO |
Practice Address |
5923 Clark Rd Ste C Paradise CA 95969 |
Practice Telephone | 5308723710 |
Practice Fax Number | 5308727234 |
Mailing Telephone | 5308723710 |
Mailing Fax Number | 5308727234 |
Enumeration Date | 2010-09-22 |
Last Update Date | 2014-12-08 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 225000000X | Orthotic Fitter | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
Y | 224L00000X | Pedorthist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Street Address |
5923 CLARK RD STE C |
City | PARADISE |
State | CA |
Zip Code | 95969 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841321403 | 2nd Sole-custom Shoes & Orthotics, Inc | Durable Medical Equipment & Medical Supplies | 5923 Clark Rd, Suite C, Paradise, CA 95969-4866 | 2007-03-08 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699234559 | Skala Chiropractic Inc | Chiropractor | 4413 Sierra Del Sol, Paradise, CA 95969 | 2019-03-19 |
1114463924 | Gary R Watts | Obstetrics & Gynecology | 5016 Lago Vista Way, Paradise, CA 95969 | 2017-01-18 |
1013367044 | Leslie Allison Bass | Registered Nurse | 1309 Nunneley Road, Paradise, CA 95969 | 2016-06-21 |
1457798977 | Lisa Marie Nelson | Counselor | 5910 Clark Road Suite 179, Paradise, CA 95969 | 2013-05-23 |
1700121597 | Ann Mary Sullivan | Marriage & Family Therapist | 955 Elliott Road, Paradise, CA 95969 | 2012-12-05 |
1255631693 | Paola Maria Mccarthy | Pharmacist | 6020 Clark Rd, Paradise, CA 95969 | 2010-11-02 |
1871821678 | Lisa Alison Franco | Occupational Therapist | 1633 Cypress Ln., Lifehouse/cypress, Paradise, CA 95969 | 2009-12-07 |
1700017548 | Michael C Reilly | Occupational Therapy Assistant | 1633 Cypress Lane, Paradise, CA 95969 | 2009-07-28 |
1992985899 | James D Salomone | Counselor | 7690 East Rd, Redwood Valley, CA 95969 | 2007-11-07 |
1548461619 | Paradise Ultrasound | Radiologic Technologist | 5921 Clark Rd, Ste. C, Paradise, CA 95969 | 2007-05-29 |
Find all providers in zip 95969 |
Taxonomy Code | 224L00000X |
Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Classification | Pedorthist |
An individual who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. |
Notes: Source: National Uniform Claim Committee [7/1/2010: new] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750993572 | Rachel Olivares | Pedorthist | 13193 Lavonda St, Eastvale, CA 92880-0789 | 2020-08-21 |
1871130781 | Matthew Maltezos | Pedorthist | 6536 E Spring St, Long Beach, CA 90815-1554 | 2019-12-10 |
1295378891 | Jennifer Faria | Pedorthist | 301 Georgia St Ste 322, Vallejo, CA 94590-5945 | 2019-10-26 |
1134689607 | Jesse Bittle | Pedorthist | 1830 Hacienda Dr Ste 5, Vista, CA 92081-4544 | 2019-03-21 |
1467929307 | Jennifer Faria | Pedorthist | 438 Annette Ave, Vallejo, CA 94591-6574 | 2018-10-29 |
1730600222 | Chris Bonsall Sr. | Pedorthist | 1350 Grant Rd Ste 14b, Mountain View, CA 94040-3248 | 2017-07-05 |
1245750140 | Judy Burke Morabito | Pedorthist | 801 Dolliver Street, Pismo Beach, CA 93449 | 2017-06-21 |
1548701675 | Gill L Majko | Pedorthist | 4941 E Walnut St # 7, Soquel, CA 95073-2433 | 2017-03-08 |
1740655448 | Michael Wells | Pedorthist | 1835 Chicago Ave, Unit A, Riverside, CA 92507-2378 | 2015-12-07 |
1659701993 | Harold Peters | Pedorthist | 685 Mary St, Redding, CA 96001-0310 | 2013-11-23 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.