Kent Gregory Brockmann, MD

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

44519 Issued in MN

Practice address

8673 Eagle Point Blvd
Lake Elmo, MN 55042

Phone

(651) 209-9383

Fax

(651) 209-9384

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Bachmann and Associates, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lake Elmo, MN
  • NPI 1144210899
  NPD (past)
• Bachmann and Associates, Inc. Dba Counseling Care

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lake Elmo, MN
  • NPI 1538158506

  Mental Health (Including Community Mental Health Center)

  NPD (past)
• Psych Recovery Inc

  • Psychiatry Physician
  • Saint Paul, MN
  • NPI 1316189541
  NPD (past)
• Psychiatric Recovery PA

  • Adolescent and Children Mental Health Clinic/Center
  • Saint Paul, MN
  • NPI 1891713681

  Adult Mental Health

  NPD (past)
• Skeleton Key Counseling LLC

  • Mental Health Counselor
  • Lake Elmo, MN
  • NPI 1831879238
  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1245281823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8673 EAGLE POINT BLVD",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "55042",
            "telephone_number": "651-209-9383",
            "fax_number": "651-209-9384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8673 EAGLE POINT BLVD",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "55042",
            "telephone_number": "651-209-9383",
            "fax_number": "651-209-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMANN",
        "first_name": "KENT",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "44519",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "44519",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "WI",
            "license": "48376-20",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087897900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD MN",
            "identifier": "273L3BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA/UBH ID",
            "identifier": "15-45530",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blossom Towne Enterprises
• Carolyn Marie Bollinger, LICSW
• Mari Boyd, M.A., LMFT
• John Arthur Bragstad, LMFT
• Broadstone Medical, P.C.
• Alexandra Nicole Brown, MA, LPCC
• Emily Clara Jindra Cable, DPT
• Bruce Douglas Campbell, DDS
• Amee Natvar Chandrabalan, D.O.
• Hope Chang

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lake Elmo, MN
• Providers in Lake Elmo, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.