NPIMap

Individual provider Active NPI

Jeromy Brink, MD

  • Vascular Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1003876269
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
31491 Issued in AZ
Practice address
6040 N 7TH St Ste 105
Phoenix, AZ 85014-1803
Phone
(602) 277-7430
Fax
(602) 279-5333
NPI assigned
Mar 23, 2006
Last updated
Jun 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 31491 AZ Primary

Addresses

Primary practice location

6040 N 7TH St Ste 105
Phoenix, AZ 85014-1803

Mailing address

2320 N 3Rd St
Phoenix, AZ 85004-1303
Phone (602) 258-9900

Other identifiers 1

IdentifierTypeStateIssuer
793910MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040601000781 AZ Practitioner - Vascular Surgery 5496737884 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Arizona College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arizona Advanced Surgery LLCGroup PAC ID 0547690166, 93 clinicians
Sandstone Medical Alliance LLCGroup PAC ID 1759852775, 8 clinicians

Practice addresses (Care Compare)

2320 N 3Rd St
Phoenix, AZ 85004-1303
Phone (602) 340-0201

6040 N 7TH St
Suite 105
Phoenix, AZ 85014-1803
Phone (602) 277-7430

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.9 of 100Reported as group
Promoting interoperability
94
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal117
Leg revascularization (restoring blood flow)61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
31491AZMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Arizona Healthcare Corporation CurrentSince Jun 1, 2020 Accepting new patients
Arizona Advanced Surgery LLC Surgery CurrentSince Apr 1, 2020 Accepting new patients
Northern Arizona Healthcare Corporation Surgery CurrentSince Jun 1, 2020 Accepting new patients
Richard J Harding MD PC Surgery Current Accepting new patients
Banner - University Medical Center Phoenix Past Accepting new patients

Locations

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

1215 N Beaver St
Flagstaff, AZ 86001
Phone (928) 773-2200

1215 N Beaver St
Ste 203
Flagstaff, AZ 86001
Phone (928) 773-2249

1895 N Jasper Dr
Ste 1
Flagstaff, AZ 86001
Phone (928) 213-6527

2945 S Dobson Rd
#2320N
Mesa, AZ 85202

2320 N 3rd St
Phoenix, AZ 85004
Phone (602) 258-3262

3033 N Central Ave
Ste 610
Phoenix, AZ 85012
Phone (602) 266-1556

6040 N 7th St
Ste 105
Phoenix, AZ 85014
Phone (602) 277-7430

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGJBCD
  • Direct secure messaging: jbrink191034@cityofhope.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1003876269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041303",
            "telephone_number": "602-258-9900",
            "fax_number": "602-258-9904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 N 7TH ST STE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850141803",
            "telephone_number": "602-277-7430",
            "fax_number": "602-279-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRINK",
        "first_name": "JEROMY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "31491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "793910",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.