DR. LAURENCE MARTIN JR. BRADLEY (M.D.) – Dermatology Physician, NPI 1639516313

DR. LAURENCE MARTIN JR. BRADLEY (M.D.) is a healthcare provider. based in Peoria, Illinois. specializing in DERMATOLOGY. They hold the professional credentials M.D.. They hold a License No. 036.142867 (IL). The NPI Number for DR. LAURENCE MARTIN JR. BRADLEY (M.D.) is 1639516313

Main info

Male
Sole Proprietor
13 Years Of Experience
Accepts Medicare Assignment
Name
DR. LAURENCE MARTIN JR. BRADLEY (M.D.)
NPI
1639516313
Phone
(309) 674-7546
Address
4909 N. GLEN PARK PLACE
Enumeration Date
4 June 2013
Last Update Date
3 January 2023

Doctor Profile

Medical School Name
HOWARD UNIVERSITY COLLEGE OF MEDICINE
Secondary Phone
6304438855
Graduation Year
2013 (13 years ago)
PAC ID
1153692629
Group Practice PAC ID
6204890460
Professional Enrollment ID
I20170801002584
Address ID
IL601741478SA2560XRDXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience55
Completeness75
Years active:13State licenses:1Digital endpointsOther names

703 DERMATOLOGY in IL

Provider Addresses for DR. LAURENCE MARTIN JR. BRADLEY (M.D.)

  • 4909 N. GLEN PARK PLACE

    PEORIA, IL 616144676

    Phone: (309) 674-7546

    Fax: (309) 282-2075

    Type: Mailing

  • 2230 HUNTINGTON DR N

    ALGONQUIN, IL 601024419

    Phone: (847) 603-4146

    Fax: (847) 960-3675

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 119 Open Payments records for all available years, with a total value of $3,063.

Total Amount is formed as General ($3,063) + Research ($0) + Ownership ($0) = $3,063.

Last reported payment date: 2024-12-27 • Largest payer in this snapshot: Organogenesis Inc. ($929).

Total Amount

$3,063

General + Research + Ownership

Payments

119

Total payment records

General Amount

$3,063

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-27

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2017-08-01

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20170801002584IDermatologyILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths13615$0
99213Established patient office or other outpatient visit, 20-29 minutes5631$0
17000Destruction of precancer skin growth, 1 growth3626$0
99203New patient office or other outpatient visit, 30-44 minutes3232$0
11311Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm2215$0
View full utilization report →

Insurance plans in this area (ZIP 61614)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6204890460View full group profile
NameSpecialtyState
Physician AssistantIL
Physician AssistantIL
Pathology, Dermatology, Dermatology, PathologyIL
D E R M A T O L O G YIL

Reviews

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Frequently asked questions

What is DR. LAURENCE MARTIN JR. BRADLEY (M.D.)'s NPI number?
DR. LAURENCE MARTIN JR. BRADLEY (M.D.)'s NPI is 1639516313 — the number used across U.S. healthcare to identify this provider.
Is DR. LAURENCE MARTIN JR. BRADLEY (M.D.) still an active registrant?
DR. LAURENCE MARTIN JR. BRADLEY (M.D.) carries an active NPI according to the public dataset.
What clinical focus is listed for DR. LAURENCE MARTIN JR. BRADLEY (M.D.)?
At a glance, DR. LAURENCE MARTIN JR. BRADLEY (M.D.) is tied to Dermatology Physician. Clinical services aligned with this taxonomy classification.
Is DR. LAURENCE MARTIN JR. BRADLEY (M.D.) located near Peoria?
DR. LAURENCE MARTIN JR. BRADLEY (M.D.) currently maps to Peoria, Illinois in this extract.
Can I trust this NPI listing for DR. LAURENCE MARTIN JR. BRADLEY (M.D.)?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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