Brooke Marie Stidham, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA08059 Issued in TX

Practice address

11623 Angus Rd
Suite 25
Austin, TX 78759-4003

Phone

(512) 345-9411

NPI assigned

Jan 26, 2010

Last updated

Mar 20, 2017By the provider in NPPES

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

Other names 1

• Miss Brooke Marie Williamson Other name

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ladera Park Dermatology PAGroup PAC ID 5597030189, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ladera Park Dermatology PA

  • Dermatology Physician
  • Austin, TX
  • NPI 1225567704
  Medicare reassignment Care Compare group
• Austin Dermatology Clinic, PA

  • Dermatology Physician
  • Austin, TX
  • NPI 1861501736
  NPD (past)
• Ladera Park Dermatology, P.a.

  • Dermatology Physician
  • Austin, TX
  • NPI 1417010935
  NPD (past)

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489968000000",
    "number": "1134450497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11671 JOLLYVILLE RD",
            "address_2": "STE 104",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594141",
            "telephone_number": "512-345-3599",
            "fax_number": "512-345-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11623 ANGUS RD",
            "address_2": "SUITE 25",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594003",
            "telephone_number": "512-345-9411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "BROOKE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-26",
        "last_updated": "2017-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "WILLIAMSON",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "PAC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• STH, PLLC (Brushy Creek Dentistry)
• Kayla Brooke Stibley, MS, RDN, LD
• Erin Jessica Stibral, P.A.- C
• Jimmy L Stickles, MD
• Wendy M. Stickley, SLP
• Ashley Stiegler, M.D.
• Karen Lee Stierman, M.D.
• Darrell C Stiffey Jr.
• Sheryl Lynn Stiffler, LMFT
• Leanne Marie Stigler, LMT

• Physician Assistant in Austin, TX
• Providers in Austin, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2017; 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.