BRADFORD BENNETT, MD — NPI 1609308105 (Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist) in FORT WORTH, TX)

CMS-1500 Box 24J / 33a • NPI

1609308105

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

2085R0202X (CMS 30)

Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)

Box 32 Service Location & ZIP+4

815 PENNSYLVANIA AVE, FORT WORTH, TX, 76104-2224

✓ 9-Digit EDI 837 ZIP+4 (76104-2224)

Practice Phone & Referral Fax

(817) 321-0404

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1609308105 (BRADFORD BENNETT, MD) 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	`1609308105` (NPI-1 Individual Practitioner)
Provider / Legal Name	BRADFORD BENNETT, MD
Plain-English Specialty	Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist) NUCC Code: `2085R0202X` (Radiology, Diagnostic Radiology)
Certifying / Licensing Body	American Board of Radiology (ABR) / FRCR
Practice Location Address	815 PENNSYLVANIA AVE, FORT WORTH, TX, 76104-2224
Practice Telephone / Fax	Tel: (817) 321-0404
Administrative Mailing Address	816 W CANNON ST, FORT WORTH, TX, 76104-3146
Enumeration & Last Sync	Enumerated: 2017-04-03 \| CMS Record Updated: 2026-05-12

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

815 PENNSYLVANIA AVE, FORT WORTH, TX, 76104-2224

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Plain-English Taxonomy & CMS Crosswalk (2085R0202X)

What Does Taxonomy Code 2085R0202X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2085R0202X translates to:
"Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 30 (Physician/Diagnostic Radiology)
Certifying / Accrediting Authority: American Board of Radiology (ABR) / FRCR
Clinical Scope: Referred by your physician for accurate medical imaging interpretation (Ultrasound, CT, MRI, Mammogram, or X-ray) or image-guided biopsy.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BRADFORD BENNETT, MD)

Typical CPT / Diagnostic Procedures:

Non-Contrast CT KUB for Urolithiasis & Contrast CT Chest/Abdomen/Pelvis
Brain, Spine & Musculoskeletal Magnetic Resonance Imaging (MRI)
Abdominal, Hepatic, Renal, Pelvic & Vascular Doppler Ultrasound
3D Digital Screening & Diagnostic Mammography (BI-RADS Reporting)

Common Therapeutic Classes:

Iodinated Low-Osmolar Intravenous CT Contrast Media (Iohexol, Iopamidol)
Gadolinium-Based MRI Contrast Agents
Barium Sulfate & Oral Gastrografin Gastrointestinal Contrast

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: CO \| License: `DR.0073875` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: UT \| License: `14213246-1235` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: FL \| License: `ME170736` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: OR \| License: `MD221169` \| Primary: Secondary
`390200000X` — Student in an Organized Health Care Education/Training Program Plain English: Licensed & Credentialed Student in an Organized Health Care Education/Training Program	State: N/A \| License: `Verified` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: KS \| License: `04-49828` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: MT \| License: `MED-PHYS-LIC-149152` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: NH \| License: `24502` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: TX \| License: `T9639` \| Primary: Yes (Primary)

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BRADFORD BENNETT, MD (NPI #1609308105)