DR. KENNETH RYAN SHACKELFORD (DNP, APRN, FNP-BC) – Family Nurse Practitioner, NPI 1811774417
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7,017 NURSE PRACTITIONER in MO
Provider Addresses for DR. KENNETH RYAN SHACKELFORD (DNP, APRN, FNP-BC)
500 Chesterfield Ctr Ste 250
Chesterfield, MO 630174833
Phone: (636) 519-8889
Type: Location
16607 EVERGREEN FOREST DR
WILDWOOD, MO 630111800
Phone: (314) 379-4344
Type: Mailing
1405 N TRUMAN BLVD
FESTUS, MO 630281177
Phone: (636) 933-2243
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $509.
Total Amount is formed as General ($509) + Research ($0) + Ownership ($0) = $509.
Last reported payment date: 2024-10-29 • Largest payer in this snapshot: Nevro Corp. ($364).
Total Amount
$509
General + Research + Ownership
Payments
7
Total payment records
General Amount
$509
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Nevro Corp. | $364 |
| Medtronic, Inc. | $126 |
| Curonix LLC | $19 |
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: 2023-10-26
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20231026000886 | I | Nurse Practitioner | MO | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 39 | 37 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 18 | 17 | $0 |
Insurance plans in this area (ZIP 63017)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Interventional Pain Management, Anesthesiology, Anesthesiology, Pain Management | MO | |
| Interventional Pain Management | IL | |
| Pain Management | MO | |
| Orthopedic Surgery | IL | |
| Diagnostic Radiology, Interventional Radiology, Interventional Radiology | MO | |
| Nurse Practitioner | MO | |
| Interventional Pain Management, Anesthesiology | NC | |
| Nurse Practitioner | MO |
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