Bradford Wilson, TLLP is a medicare enrolled "Psychologist" provider in Stevensville, Michigan. His current practice location is
5675 Fairview St, Stevensville, Michigan. You can reach out to his office (for appointments etc.) via phone at
(269) 429-7727.
Bradford Wilson is licensed to practice in Michigan (license number 6361007564) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1396081451.
Healthcare Provider's Profile
| Full Name | Bradford Wilson |
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| Gender | Male |
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| Speciality | Psychologist |
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| Location | 5675 Fairview St, Stevensville, Michigan |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1396081451
- Provider Enumeration Date: 12/18/2012
- Last Update Date: 02/10/2025
Medicare PECOS Information:
- PECOS PAC ID: 0345781266
- Enrollment ID: I20240919000563
Medical Identifiers
Medical identifiers for Bradford Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1396081451 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | 6301015339 (Michigan) | Secondary |
| 101Y00000X | Counselor | 6361007564 (Michigan) | Secondary |
| 103T00000X | Psychologist | 6361007564 (Michigan) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Bradford Wilson allows following entities to bill medicare on his behalf.
| Entity Name | Lakeland Hospitals At Niles And St Joseph Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1134220031
PECOS PAC ID: 7517929037
Enrollment ID: O20041027001172 |
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| Entity Name | Lakeland Medical Practices |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1538397120
PECOS PAC ID: 1658427042
Enrollment ID: O20090928000216 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Bradford Wilson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Bradford Wilson, TLLP
5675 Fairview St,
Stevensville, MI 49127-1033
Ph: (269) 429-7727 | Bradford Wilson, TLLP
5675 Fairview St,
Stevensville, MI 49127-1033
Ph: (269) 429-7727 |
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