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Deactivated NPI 1134197924 Deactivated / Inactive NPI Male Practitioner

Dr. Kenneth Bradshaw , DPM

Podiatrist • Clinton, MO

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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, Dr. Kenneth Bradshaw has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 09, 2006
NPI Deactivation Date August 28, 2025
Total Practice Duration ~19 Years of Practice (2006 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Bradshaw, DPM was a registered Podiatrist practicing in Clinton, MO. Throughout an active medical career spanning 19 years, Dr. Bradshaw provided care at the practice location at 1602 N 2ND ST until profile deactivation on 2025-08-28.

Historical Medicare Part B clinical services included removal of fingernails or toenails, removal of noncancer thickened skin growth, more than 4 growths, drainage of blood or fluid accumulation. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1602 N 2nd St

Clinton, MO 647351192

Telephone 6608858171
Fax 6608908485
Associated Practice Facility / Clinic
🏢 Jg Sanford Llc Facility NPI 1912094566

Specialty Benchmarks & Practice Insights

Comparative analytics for Podiatrist in Clinton, MO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 25.5 Yrs
Regional Practice Density
1 Specialists

Practicing in Clinton, MO (156 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
78.7% 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
11721 Removal of fingernails or toenails, 6 or more nails
46 32 $97.00 $24.63
11057 Removal of noncancer thickened skin growth, more than 4 growths
45 31 $147.96 $27.50

Medical Specialties & State Licenses

Podiatrist Primary Specialty

NUCC Taxonomy Code: 213E00000X

State License MO 000385

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Practice Associates & Co-Workers

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

40 Associated Practitioners
Dr. James Clouse , DO

Internal Medicine

NPI 1033187877

Doctor of Osteopathic Medicine (D.O.)

Emily Baker , FNP

Nurse Practitioner - Family

NPI 1033406251

Family Nurse Practitioner

Dr. Alice Ruttinger , DO

Internal Medicine

NPI 1043395163

Doctor of Osteopathic Medicine (D.O.)

Mary Huggins , FNP

Nurse Practitioner - Family

NPI 1093003030

Family Nurse Practitioner

Dr. Bruce Bellamy , MD

Family Medicine

NPI 1093747057

Doctor of Medicine (M.D.)

Emily Bellamy , PA

Physician Assistant - Medical

NPI 1114678505

Physician Assistant

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated August 28, 2025

Record deactivated on August 28, 2025

NPI Profile Active December 29, 2009

NPI status registered as active in NPPES database

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Updated Practice Location December 29, 2009

Registered at 1602 N 2ND ST, CLINTON, MO 647351192 (Tel: 6608858171)

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Updated Business Mailing Address December 29, 2009

Registered at 1602 N 2ND ST, CLINTON, MO 647351192 (Tel: 6608858171)

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Provider Name / Credentials Updated December 29, 2009

Recorded as KENNETH BRADSHAW, D.P.M.

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 29, 2009

Podiatrist (License #000385 in MO)

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Initial NPI Registration & Enumeration March 09, 2006

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: 1134197924
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 09, 2006
Last Update: December 29, 2009
Deactivation Date: August 28, 2025

Mailing Address

1602 N 2nd St

Clinton, MO 647351192

Phone: 6608858171

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.