STEPHEN R BRADDOCK (MD) – Clinical Genetics (M.D.) Physician, NPI 1811934490
Clinical Genetics (M.D.) Physician
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Profile Insights
NPPES metrics only — not quality of care.
16 MEDICAL GENETICS AND GENOMICS in MO
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Provider Addresses for STEPHEN R BRADDOCK (MD)
SSM Health Cardinal Glennon Children’s Hospital, 1465, South Grand Boulevard, Tiffany, City of Saint Louis, Missouri, 63104, United States
SAINT LOUIS, MO 631041003
Phone: (314) 577-5639
Fax: (314) 268-4112
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2010-08-17
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 |
|---|---|---|---|---|
| I20100817001459 | I | Medical Genetics And Genomics | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 63104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Anesthesiology Assistant | MO | |
| Pediatric Medicine, Hematology/Oncology | TN | |
| Nurse Practitioner | IL | |
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| Pediatric Medicine | IL | |
| G A S T R O E N T E R O L O G Y | WV | |
| Pediatric Medicine, Cardiovascular Disease (Cardiology) | MO | |
| Infectious Disease | OH | |
| Physician Assistant | MO | |
| Pediatric Medicine, Cardiovascular Disease (Cardiology) | MO |
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