NPIMap

Individual provider Active NPI

Blake Jay Brooks, M.D.

  • Nephrology Physician
  • Columbia, MO
National Provider Identifier
1255337390
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
119892 Issued in MO
Practice address
1205 W Broadway
Columbia, MO 65203-2125
Phone
(573) 499-0642
Fax
(573) 449-1787
NPI assigned
Jun 23, 2005
Last updated
Oct 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 119892 MO Primary

Addresses

Primary practice location

1205 W Broadway
Columbia, MO 65203-2125

Mailing address

1205 W Broadway
Columbia, MO 65203-2125
Phone (573) 499-0642

Other identifiers 13

IdentifierTypeStateIssuer
208373407MedicaidMO
H51820OtherMOMERCY
000623655OtherMOHUMANA
110245813OtherMORAILROAD MEDICARE
539285OtherMOHEALTHLINK
7359531OtherMOAETNA
143480OtherMOGROUP HEALTH PLANS
1963097OtherMOFIRST HEALTH
P01764602OtherMORAILROAD MEDICARE
3100264OtherMOUNITED HEALTHCARE
431535214OtherMOTRICARE
178793OtherMOBLUE CROSS BLUE SHIELD
42482OtherMOHEALTHCARE USA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BJBrooks@nhacolumbia.ssdirect.aprima.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20090317000640 MO Practitioner - Nephrology 5991867608 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Missouri, Columbia School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology and Hypertension AssociatesGroup PAC ID 9830182534, 7 clinicians

Practice addresses (Care Compare)

1205 N Missouri St
Macon, MO 63552-2095
Phone (573) 499-0642

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.96 of 100Reported as individual
Quality
56.52
Improvement activities
40
Cost
64.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: bjbrooks@nhacolumbia.ssdirect.aprima.com

Organizations & group practices 1

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1255337390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 W BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652032125",
            "telephone_number": "573-499-0642",
            "fax_number": "573-449-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 W BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652032125",
            "telephone_number": "573-499-0642",
            "fax_number": "573-449-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "BLAKE",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "119892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208373407",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY",
            "identifier": "H51820",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "000623655",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110245813",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "539285",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7359531",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLANS",
            "identifier": "143480",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "1963097",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01764602",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "3100264",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "431535214",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "178793",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE USA",
            "identifier": "42482",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BJBrooks@nhacolumbia.ssdirect.aprima.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1205 W Broadway",
            "city": "Columbia",
            "state": "MO",
            "country_code": "US",
            "postal_code": "652032125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.