Active NPI
Robert John Bradshaw, M.D.
- Pediatrics Physician
- Saint Peters, MO
National Provider Identifier
1558335638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- R2C09
- Practice address
- 107 Piper Hill Dr
Suite 130
Saint Peters, MO 63376-1651 - Phone
- (636) 928-5950
- Fax
- (636) 928-5952
- NPI assigned
- Feb 15, 2006
- Last updated
- Feb 9, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | R2C09 | MO | Primary |
Addresses
Primary practice location
107 Piper Hill Dr
Suite 130
Saint Peters, MO 63376-1651
Mailing address
107 Piper Hill Dr
Suite 130
Saint Peters, MO 63376-1651
Phone (636) 928-5950
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R2C09 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic East Communities | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- rbradshaw115@directc.mercy.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328745600000",
"number": "1558335638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 PIPER HILL DR",
"address_2": "SUITE 130",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633761651",
"telephone_number": "636-928-5950",
"fax_number": "636-928-5952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 PIPER HILL DR",
"address_2": "SUITE 130",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633761651",
"telephone_number": "636-928-5950",
"fax_number": "636-928-5952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "ROBERT",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-15",
"last_updated": "2012-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "R2C09",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.