Jennifer A Brake, MD

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

01058572A Issued in IN

Practice address

111 W Jefferson Blvd
Ste 100
South Bend, IN 46601-1994

Phone

(574) 647-1669

Fax

(574) 239-6461

NPI assigned

Aug 10, 2006

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 identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1093726713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W JEFFERSON BLVD",
            "address_2": "STE 100",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011994",
            "telephone_number": "574-647-1669",
            "fax_number": "574-239-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAKE",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IN",
            "license": "01058572A",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01058572A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BMG E. BLAIR WARNER",
            "identifier": "000000914885",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BMG SPORTS MEDICINE",
            "identifier": "000000914879",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200475200",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leena Bradley
• Shanti Bradley, M.ED., MBA, BCBA
• Jennae Bradshaw
• Linda Disire Bradshaw
• Ashley D Bragg, M.S., CCC-SLP
• Amy Elizabeth Branch, RD
• Cynthia Da'Jean Branch
• Oleishia Branch
• Mary Fran Brandenberger, LCSW
• Terry Brasfield II, LSW

• Sports Medicine (Family Medicine) Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Sports Medicine (Family Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.