Stephen R Braddock, MD is a medicare enrolled "Medical Genetics - Clinical Genetics (m.d.)" physician in St. Louis, Missouri. His current practice location is
1465 S Grand Blvd, St. Louis, Missouri. You can reach out to his office (for appointments etc.) via phone at
(314) 577-5639.
Stephen R Braddock is licensed to practice in Missouri (license number 106085) 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 1811934490.
Physician's Profile
| Full Name | Stephen R Braddock |
|---|
| Gender | Male |
|---|
| Speciality | Medical Genetics - Clinical Genetics (m.d.) |
|---|
| Location | 1465 S Grand Blvd, St. Louis, Missouri |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1811934490
- Provider Enumeration Date: 06/01/2006
- Last Update Date: 01/15/2021
Medicare PECOS Information:
- PECOS PAC ID: 2062414717
- Enrollment ID: I20100817001459
Medical Identifiers
Medical identifiers for Stephen R Braddock such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1811934490 | NPI | - | NPPES |
| 762132 | Medicaid | VA | |
| 207684309 | Medicaid | MO | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | MD106085 (Missouri) | Secondary |
| 207SG0201X | Medical Genetics - Clinical Genetics (m.d.) | 106085 (Missouri) | 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. Stephen R Braddock allows following entities to bill medicare on his behalf.
| Entity Name | Ssm Health Care Group |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1306589544
PECOS PAC ID: 0143608372
Enrollment ID: O20220531002655 |
|---|
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. Stephen R Braddock 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 |
|---|
Stephen R Braddock, MD
1465 S Grand Blvd,
Saint Louis, MO 63104-1003
Ph: (314) 577-5639 | Stephen R Braddock, MD
1465 S Grand Blvd,
St. Louis, MO 63104-1003
Ph: (314) 577-5639 |
Reviews and Comments