NPIMap

Individual provider Active NPI

Sally Bishop Brooks, PA-C

  • Medical Physician Assistant
  • Lawerenceville, GA
National Provider Identifier
1104948405
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
003149 Issued in GA
Practice address
1000 Medical Center Blvd
Lawerenceville, GA 30054
Phone
(678) 442-3317
NPI assigned
Apr 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 003149 GA Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Lawerenceville, GA 30054

Mailing address

1000 Medical Center Blvd
Lawrenceville, GA 30045-7694

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL sally.brooks@envisionhealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070724000369 GA Practitioner - Physician Assistant 9739280546 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gwinnett Emergency Specialists Observation Services LLCGroup PAC ID 7618140955, 38 clinicians
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (954) 939-5000

1285 Upper Hembree Rd
Roswell, GA 30076-1143
Phone (770) 343-8565

3620 Howell Ferry Rd
Duluth, GA 30096-3178
Phone (954) 939-5000

Hospital & facility affiliations

  • Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
  • Northside Hospital Duluth Hospital, Duluth, GA, CCN 110252

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
67.82
Promoting interoperability
77
Improvement activities
40
Cost
77.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20284CAMDClinical Social Worker
003149GAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Parkway Anesthesia Consultants, PC Past Accepting new patients
Cherokee Emergency Services, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sbrooks119544@capefearvalley.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1104948405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300457694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWERENCEVILLE",
            "state": "GA",
            "postal_code": "30054",
            "telephone_number": "678-442-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "SALLY",
        "middle_name": "BISHOP",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "003149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "sally.brooks@envisionhealth.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1000 Medical Center Blvd",
            "city": "Lawerenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lawerenceville, GA

Sources for this page

Verify at the official NPI Registry.