Individual provider Active NPI

Chad M Brooks, PA-C

  • Physician Assistant
  • Germantown, TN
National Provider Identifier
1063505857
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1497 Issued in TN
Practice address
1400 S Germantown Rd
Germantown, TN 38138-2205
Phone
(901) 759-3100
Fax
(901) 747-1001
NPI assigned
Oct 2, 2006
Last updated
Oct 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1497 TN Primary
Physician Assistant 363A00000X 104187 NC
Surgical Physician Assistant 363AS0400X 1497 TN

Addresses

Primary practice location

1400 S Germantown Rd
Germantown, TN 38138-2205

Mailing address

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

Other identifiers 2

IdentifierTypeStateIssuer
08057569MedicaidMS
Q067968MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20071005000039 TN Practitioner - Physician Assistant 0446207211 Reassigns benefits to 1 organization
I20080501000292 MS Practitioner - Physician Assistant 0446207211 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75.09 of 100Reported as group
Quality
50.47
Promoting interoperability
99
Improvement activities
40
Cost
67.33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1497TNMDAddiction (Substance Use Disorder) Counselor
104187NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Clinic, PC Physician Assistant CurrentSince Mar 31, 2021 Accepting new patients
Campbell Clinic PC CurrentSince Mar 31, 2021 Accepting new patients
Baptist Minor Medical Centers Inc Physician Assistant Current Accepting new patients
Asheville MRI Past Accepting new patients
CC Bpci PLC Past Accepting new patients

Locations

2608 S Lamar Blvd
Ste 102
Oxford, MS 38655
Phone (901) 759-3111

7545 Airways Blvd
Southaven, MS 38671
Phone (901) 759-3196

1458 W Poplar Ave
Ste 100
Collierville, TN 38017
Phone (901) 759-5491

1211 Union Ave
Ste 500
Memphis, TN 38104
Phone (901) 759-3275

1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111

3295 Poplar Ave
Ste 105
Memphis, TN 38111
Phone (901) 327-8188

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1063505857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-3100",
            "fax_number": "901-747-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-3100",
            "fax_number": "901-747-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "CHAD",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1497",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "104187",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "1497",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08057569",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q067968",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

Verify at the official NPI Registry.