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Deactivated NPI 1003095548 Deactivated / Inactive NPI Male Practitioner

Bradshaw Michael Mallard , PA

Physician Assistant • Taylor, MI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Bradshaw Mallard has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 01, 2007
NPI Deactivation Date May 31, 2022
Total Practice Duration ~15 Years of Practice (2007 – 2022)

Professional Overview & Biography Verified Profile Summary

Bradshaw Mallard, PA was a registered Physician Assistant practicing in Taylor, MI. Throughout an active medical career spanning 15 years, Bradshaw Mallard provided care at the practice location at 21801 GODDARD RD until profile deactivation on 2022-05-31.

Historical Medicare Part B clinical services included subsequent nursing facility care with high level of medical decision making, per day, if using time, at least, subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

21801 Goddard Rd
Wsupg Pm&r Oakwood

Taylor, MI 481804213

Telephone 3134387373
Fax 3134387375
Associated Practice Facility / Clinic
🏢 Us Rehabilitatiln,inc Facility NPI 1255383295

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Taylor, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 13.7 Yrs
State Avg: 12.2 Yrs
Regional Practice Density
9 Specialists

Practicing in Taylor, MI (7057 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
53.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2019)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99310 Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes
109 95 $256.17 $118.08

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License MI 5601001586

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Dr. Riley Smith , MD

Physical Medicine & Rehabilitation

NPI 1285923649

Doctor of Medicine (M.D.)

Dr. Darren Fuerst , PhD

Clinical Neuropsychologist

NPI 1437148137

Doctor of Philosophy (Ph.D.)

Dr. Johnathan Ho , MD

Physical Medicine & Rehabilitation

NPI 1710274386

Doctor of Medicine (M.D.)

Dr. Annette Desantis , MD

Physical Medicine & Rehabilitation

NPI 1730135492

Doctor of Medicine (M.D.)

Jennifer Welch , CNP

Nurse Practitioner - Acute Care

NPI 1730497595

Certified Nurse Practitioner

Dr. Michael Yoshida , MD

Physical Medicine & Rehabilitation

NPI 1871545244

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

12 Historical Events
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NPI Profile Deactivated May 31, 2022

Record deactivated on May 31, 2022

NPI Profile Active September 18, 2017

NPI status registered as active in NPPES database

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Updated Practice Location September 18, 2017

Registered at 14585 NORTHLINE RD, SOUTHGATE, MI 481952469 (Tel: 7342840635)

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Updated Business Mailing Address September 18, 2017

Registered at PO BOX 4000, SOUTHFIELD, MI 480374000 (Tel: (734) 284-0635)

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Provider Name / Credentials Updated September 18, 2017

Recorded as BRADSHAW MALLARD, PA

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 18, 2017

Physician Assistant (License #5601001586 in MI)

NPI Profile Active June 07, 2016

NPI status registered as active in NPPES database

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Updated Practice Location June 07, 2016

Registered at 21801 GODDARD RD, WSUPG PM&R OAKWOOD, TAYLOR, MI 481804213 (Tel: 3134387373)

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Updated Business Mailing Address June 07, 2016

Registered at 1560 E. MAPLE RD., SUITE 400- CREDENTIALING, TROY, MI 480831189 (Tel: 7342840865)

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Provider Name / Credentials Updated June 07, 2016

Recorded as BRADSHAW MALLARD, PA

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 07, 2016

Physician Assistant (License #5601001586 in MI)

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Initial NPI Registration & Enumeration November 01, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1003095548
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 01, 2007
Last Update: June 07, 2016
Deactivation Date: May 31, 2022

Mailing Address

1560 E. Maple Rd., Suite 400- Credentialing

Troy, MI 480831189

Phone: 7342840865

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.