Individual provider Active NPI

Brooke Kathleen Carroll

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1124726195
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009827 Issued in IL
Practice address
507 North 17TH Street
Milwaukee, WI 53233
Phone
(815) 993-8068
NPI assigned
Feb 20, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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 085009827 IL Primary

Addresses

Primary practice location

507 North 17TH Street
Milwaukee, WI 53233

Mailing address

507 North 17TH Street
Milwaukee, WI 53233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20230921002446 IL Practitioner - Physician Assistant 3173977386 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Oct 15, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

133 Spinder Dr
East Peoria, IL 61611
Phone (309) 265-7287

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1124726195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 NORTH 17TH STREET",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 NORTH 17TH STREET",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53233",
            "telephone_number": "815-993-8068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "BROOKE",
        "middle_name": "KATHLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.