Individual provider Active NPI

Brooke Birling, PA

  • Physician Assistant
  • New London, WI
National Provider Identifier
1063619336
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2145-023 Issued in WI
Practice address
1420 Algoma St
New London, WI 54961-2104
Phone
(920) 982-8300
NPI assigned
Jun 29, 2007
Last updated
Mar 19, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2145-023 WI Primary

Addresses

Primary practice location

1420 Algoma St
New London, WI 54961-2104

Mailing address

1420 Algoma St
New London, WI 54961-2104
Phone (920) 982-8300

Other identifiers 1

IdentifierTypeStateIssuer
1075095OtherWINCCPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20070814000835 WI Practitioner - Physician Assistant 8820189202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1420 Algoma St
New London, WI 54961-2104
Phone (920) 982-8300

1501 S Madison St
Appleton, WI 54915-1846
Phone (920) 738-2000

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

3329 N Richard St
Appleton, WI 54911-1063
Phone (920) 380-2715

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2145-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Sep 28, 2009 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Sep 28, 2009 Accepting new patients

Locations

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

1420 Algoma St
New London, WI 54961
Phone (920) 828-8300

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

Organizations & group practices 2

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 4

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": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395187200000",
    "number": "1063619336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 ALGOMA ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612104",
            "telephone_number": "920-982-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 ALGOMA ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612104",
            "telephone_number": "920-982-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRLING",
        "first_name": "BROOKE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2014-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2145-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1075095",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, WI

Sources for this page

Verify at the official NPI Registry.