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DATRESE MONIQUE BRADLEY LCPC
NPI 1053059949
Counselor - Professional in Carbondale, IL

Active since May 22, 2022PECOS Enrolled
103 N ROD LN, CARBONDALE, IL 62901(618) 203-6925 Get Directions Write a Review

NPPES record last updated: May 22, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Datrese Monique Bradley Lcpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DATRESE MONIQUE BRADLEY LCPC (NPI 1053059949) is an individual professional provider in Carbondale, Illinois, licensed in Illinois (180.014457) and active in the NPI registry since May 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053059949
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameDATRESE MONIQUE BRADLEYCredential: LCPC
Location Address103 N ROD LNCarbondale, IL 62901-2031
Mailing Address103 N Rod LnCarbondale, IL 62901-2031 · (618) 203-6925
Phone(618) 203-6925
Sole ProprietorYes
Enumeration DateMay 22, 2022
NPPES CertifiedMay 22, 2022
✔ NPI 1053059949 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in IL · 180.014457
103 N ROD LN, Carbondale, IL 62901
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Datrese Monique Bradley Lcpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Datrese Bradley reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mental Health Specialty Group PA
586 mi
Mental Health
110 N CORCORAN ST FL 5
Durham, NC 27701
  • Reassigned Medicare billing, Illinois enrollment
  • 107 clinicians in this Medicare group
NPI 1801472634 (323) 205-7088

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Datrese Bradley's NPI number?

The NPI number for Datrese Bradley is 1053059949. It was assigned to this individual provider in the NPPES registry on May 22, 2022.

Where is Datrese Bradley located?

Datrese Bradley practices at 103 N Rod Ln, Carbondale, IL 62901. The listed phone number is (618) 203-6925.

What is Datrese Bradley's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Datrese Bradley enrolled in Medicare?

Yes. Datrese Bradley is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Datrese Bradley's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Datrese Bradley reassigns Medicare benefits to Mental Health Specialty Group PA (Durham, NC). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Datrese Bradley's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Datrese Bradley accept?

Health plans from Oscar Health and UnitedHealthcare list Datrese Bradley as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Datrese Bradley was last updated on May 22, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.