Individual provider Active NPI

Brooke Corlew

  • Family Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1235798166
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
344489 Issued in NY
Practice address
1045 James St
Syracuse, NY 13203-2730
Phone
(315) 425-1004
NPI assigned
Jun 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 344489 NY Primary

Addresses

Primary practice location

1045 James St
Syracuse, NY 13203-2730

Mailing address

205 Manor Dr
North Syracuse, NY 13212-1010
Phone (518) 796-2735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20190723000056 NY Practitioner - Nurse Practitioner 9133455686 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Port City Emergency Physicians LLPGroup PAC ID 0345301917, 46 clinicians

Practice addresses (Care Compare)

510 S 4TH St
Suite 2
Fulton, NY 13069-2952
Phone (315) 592-3510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
344489NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Resources Inc. Current Accepting new patients
Liberty Resources, Inc. CurrentSince Jun 10, 2019 Accepting new patients
Port City Emergency Physicians LLP Current Accepting new patients
Liberty Resources, Inc. CurrentSince Jun 10, 2019 Accepting new patients
Port City Emergency Physicians LLP CurrentSince Oct 16, 2021 Accepting new patients
Port City Emergency Physicians LLP CurrentSince Oct 16, 2021 Accepting new patients

Locations

3045 East Ave
Central Square, NY 13036
Phone (315) 668-1202

510 S 4th St
Ste 2
Fulton, NY 13069
Phone (315) 592-3510

110 W 6th St
Oswego, NY 13126
Phone (315) 349-5511

1045 James St
Syracuse, NY 13203
Phone (315) 425-1004

Interoperability endpoints

  • Direct secure messaging: bcorlew@hiemail.healtheconnections.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1235798166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 MANOR DR",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132121010",
            "telephone_number": "518-796-2735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032730",
            "telephone_number": "315-425-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORLEW",
        "first_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "344489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.