Brooke Scupp

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

473 Woodhouse Loop
Irmo, SC 29063-7781

Phone

(803) 422-3754

NPI assigned

Feb 24, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pain Clinic Associates PLLCGroup PAC ID 4486610664, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167
• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Pain Clinic Associates PLLC

  • Interventional Pain Medicine Physician
  • Southaven, MS
  • NPI 1306496567
  Medicare reassignment Care Compare group NPD
• Pain Clinic Associates PLLC

  • Interventional Pain Medicine Physician
  • Memphis, TN
  • NPI 1033286513
  Medicare reassignment NPD

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

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation
• Methodist Healthcare - Olive Branch Hospital

  • General Acute Care Hospital
  • Olive Branch, MS
  • NPI 1912341439
  Care Compare affiliation

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

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1093309668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 WOODHOUSE LOOP",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290637781",
            "telephone_number": "803-422-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 WOODHOUSE LOOP",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290637781",
            "telephone_number": "803-422-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCUPP",
        "first_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-24",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Marie Schumacher, DO
• Andrea Scott
• Revekeo Scott
• Shamika Glenetta Scott, L.P.C.
• Script RX Inc (Columbia Pharmacy)
• Thomas Gordon Seastrunk, DO
• Grant L Sebastiano, D.C.
• Shady Grove Chiropractic, LLC
• Shai's Coaching and Counseling LLC (Shai's Coaching and Counseling)
• Katelyn W Sharpe, PTA

• Medical Physician Assistant in Irmo, SC
• Providers in Irmo, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.