NPIMap

Individual provider Active NPI

Brooke Nicole Deweese, P.A.

  • Medical Physician Assistant
  • Pueblo West, CO
National Provider Identifier
1174867279
Registry record updated Mar 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0003584 Issued in CO
Practice address
121 S. Crescent Drive
Pueblo West, CO 81007-5433
Phone
(719) 595-7575
Fax
(719) 288-2799
NPI assigned
Nov 15, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2016

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 PA.0003584 CO Primary

Addresses

Primary practice location

121 S. Crescent Drive
Pueblo West, CO 81007-5433

Mailing address

PO Box 560825
Denver, CO 80256-0825
Phone (719) 595-7580

Other identifiers 1

IdentifierTypeStateIssuer
89056779MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20160120001230 CO Practitioner - Physician Assistant 2668775941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Family Medicine Center, P.C.Group PAC ID 9739157827, 7 clinicians

Practice addresses (Care Compare)

4020 Jerry Murphy Rd
Pueblo, CO 81001-1045
Phone (719) 546-3600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0003584COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: brooke.deweese.1@6060.direct.athenahealth.com

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.

Hospital & facility affiliations 10

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": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456876800000",
    "number": "1174867279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560825",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802560825",
            "telephone_number": "719-595-7580",
            "fax_number": "719-545-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S. CRESCENT DRIVE",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075433",
            "telephone_number": "719-595-7575",
            "fax_number": "719-288-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWEESE",
        "first_name": "BROOKE",
        "middle_name": "NICOLE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2016-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0003584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89056779",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo West, CO

Sources for this page

Verify at the official NPI Registry.