RYAN BRADLEY, PA-C, CAQ-PSY — NPI 1235862012 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical in EGLIN, FL)

CMS-1500 Box 24J / 33a • NPI

1235862012

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363AM0700X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical

Box 32 Service Location & ZIP+4

4315 EL SALVADOR WAY, EGLIN, FL, 32542-1711

✓ 9-Digit EDI 837 ZIP+4 (32542-1711)

Practice Phone & Referral Fax

(575) 386-6585

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1235862012 (RYAN BRADLEY, PA-C, CAQ-PSY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1235862012` (NPI-1 Individual Practitioner)
Provider / Legal Name	RYAN BRADLEY, PA-C, CAQ-PSY
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical NUCC Code: `363AM0700X` (Physician Assistant, Medical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4315 EL SALVADOR WAY, EGLIN, FL, 32542-1711
Practice Telephone / Fax	Tel: (575) 386-6585
Administrative Mailing Address	6600 VAN AALST BLVD, FORT MOORE, GA, 31905-2102
Enumeration & Last Sync	Enumerated: 2022-07-07 \| CMS Record Updated: 2024-10-04

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4315 EL SALVADOR WAY, EGLIN, FL, 32542-1711

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Plain-English Taxonomy & CMS Crosswalk (363AM0700X)

What Does Taxonomy Code 363AM0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363AM0700X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant, Medical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (RYAN BRADLEY, PA-C, CAQ-PSY)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363AM0700X` — Physician Assistant, Medical Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical	State: FL \| License: `9118992` \| Primary: Yes (Primary)
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: TX \| License: `1198847` \| Primary: Secondary

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RYAN BRADLEY, PA-C, CAQ-PSY (NPI #1235862012)