| Michelle Rae Braddy, MD | |
|
203 S Main St, Dieterich, IL 62424-1128 | |
| (217) 925-5730 | |
| (217) 925-5736 |
| Full Name | Michelle Rae Braddy |
|---|---|
| Gender | Female |
| Speciality | Family Practice |
| Experience | 22 Years |
| Location | 203 S Main St, Dieterich, Illinois |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619068061 | NPI | - | NPPES |
| 14D0921285 | Other | IL | CLIA ID NUMBER |
| 036120332 | Other | IL | ILLINOIS PHYSICIAN LICENSE |
| 371391171005 | Medicaid | IL | |
| 930280 | Other | IL | HEALTHLINK |
| 2523247 | Other | IL | BLUE CROSS BLUE SHIELD |
| P00790343 | Other | IL | RAILROAD MEDICARE |
| 036120332 | Medicaid | IL | |
| 336082411 | Other | IL | ILLINOIS CONTROLLED SUBSTANCE LICENSE |
| 371391171005 | Other | IL | MEDICAID RURAL HEALTH |
| 561920 | Other | IL | MEDICARE GROUP PTAN |
| 151351 | Other | IL | HEALTH ALLIANCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036120332 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Hshs Home Care Illinois | Effingham, IL | Home health agency |
| St Anthonys Memorial Hospital | Effingham, IL | Hospital |
| St Johns Hospital | Springfield, IL | Hospital |
| Clay County Hospital | Flora, IL | Hospital |
| St Marys Hospital | Decatur, IL | Hospital |
| Sarah Bush Lincoln Health Center | Mattoon, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Hshs Medical Group Inc | 5092857821 | 212 |
| Entity Name | HSHS Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962644807 PECOS PAC ID: 5092857821 Enrollment ID: O20100116000275 |
| Mailing Address | Practice Location Address |
|---|---|
| Michelle Rae Braddy, MD 1207 Network Centre Dr, Suite 3, Effingham, IL 62401-4632 Ph: (217) 347-2707 | Michelle Rae Braddy, MD 203 S Main St, Dieterich, IL 62424-1128 Ph: (217) 925-5730 |