Inessa Pavlovna Brooks, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2887 Issued in TN

Practice address

980 Professional Park Dr
Suite a
Clarksville, TN 37040-5251

Phone

(931) 905-1001

Fax

(931) 905-0410

NPI assigned

Jan 5, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Inessa Pavlovna Chernish Former name

Medicare fee-for-service enrollment

Enrolled in TN

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Riverside Spine & Physical Medicine, PC

  • Orthopaedic Surgery Physician
  • Clarksville, TN
  • NPI 1720407570
  Medicare reassignment
• Advanced Diagnostic Imaging PC

  • Durable Medical Equipment & Medical Supplies
  • Lewisburg, TN
  • NPI 1922846559
  NPD (past)
• Advanced Diagnostic Imaging, PC

  • Internal Medicine Physician
  • Goodlettsville, TN
  • NPI 1093741464

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1013373141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3024 BUSINESS PARK CIR",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370723132",
            "telephone_number": "615-851-6033",
            "fax_number": "615-851-2018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 PROFESSIONAL PARK DR",
            "address_2": "SUITE A",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405251",
            "telephone_number": "931-905-1001",
            "fax_number": "931-905-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "INESSA",
        "middle_name": "PAVLOVNA",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-05",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "2887",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "INESSA",
            "last_name": "CHERNISH",
            "middle_name": "PAVLOVNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Liana Brock
• Wendy M Brockman, PHARMD
• Samaiyah Bronson
• Brookdale Senior Living Communities, Inc.
• Anna Victoria Brooks
• Jacqueline Nicole Brooks, RN
• Jaime Brooks
• James Brooks
• Madeline Brooks
• Rilynn Brooks

• Physician Assistant in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.