Derek Christopher Braddix

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2016025007 Issued in MO

Practice address

9717 Landmark Parkway Dr
Saint Louis, MO 63127-1628

Phone

(775) 423-6400

NPI assigned

Aug 30, 2016

Last updated

Sep 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO, IL, TX3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Complexcare Medical Group Midwest M PLLCGroup PAC ID 1355858630, 87 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: derek_braddix@medtransreno.adaptamed.direct-ci.com

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.

• Complexcare Medical Group Midwest M PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1528851607

  IL, TX

  Medicare reassignment Care Compare group NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  IL

  Medicare reassignment Care Compare group NPD
• Impact Physician Group, Missouri, LLC

  • Internal Medicine Physician
  • Bridgeton, MO
  • NPI 1962971531
  Medicare reassignment NPD
• The Health & Wellness Centerr LLC

  • Primary Care Nurse Practitioner
  • Saint Louis, MO
  • NPI 1932627486
  Medicare reassignment NPD
• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933

  IL

  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  MO

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1588110480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 MISSISSIPPI AVE APT 115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631042457",
            "telephone_number": "314-323-5316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9717 LANDMARK PARKWAY DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271628",
            "telephone_number": "775-423-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDIX",
        "first_name": "DEREK",
        "middle_name": "CHRISTOPHER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-30",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2016025007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Brackin
• Joan M Brackmann, M.A., L.P.C.
• Bracks Family Counseling (St. Louis Integrative Counseling)
• Brad McMillin, Inc (Beltone Hearing Aid Service)
• Katelyn Bradburn
• Barbara Ann Braddock, PHD MHS CCC-SLP
• Jalyn Braddock
• Rebecca Braddock
• Stephen R Braddock, MD
• Ashtynn Rae Braden, PA-C

• Family Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.