NPIMap

Individual provider Active NPI

Mark A Brockman, MD

  • Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1255382628
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
26812 Issued in KY
Practice address
5109 New Cut Rd
Louisville, KY 40214-2745
Phone
(502) 361-1197
Fax
(502) 361-0090
NPI assigned
May 12, 2006
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
Pediatrics Physician 208000000X 26812 KY Primary

Addresses

Primary practice location

5109 New Cut Rd
Louisville, KY 40214-2745

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Other identifiers 2

IdentifierTypeStateIssuer
6426812100MedicaidKY
000000050176OtherKYBLUE CROSS

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mbrockman55376@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20131205000825 KY Practitioner - Pediatric Medicine 4385871995 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children's Medical Group, LLC Current Accepting new patients
Community Medical Associates, Inc. Pediatrics CurrentSince Dec 1, 2013 Accepting new patients
Norton Children's Medical Group, LLC CurrentSince Mar 1, 2020 Accepting new patients
Community Medical Associates, Inc. CurrentSince Dec 1, 2013 Accepting new patients
Norton Children's Medical Group, LLC Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
Community Medical Associates, Inc. Current Accepting new patients
Norton Childrens Medical Group, LLC Pediatrics Past Accepting new patients

Locations

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

5109 New Cut Rd
Louisville, KY 40214
Phone (502) 361-1197

Interoperability endpoints

  • Direct secure messaging: mbrockman55376@direct.nortonhealthcare.org

Organizations & group practices 7

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1255382628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5109 NEW CUT RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402142745",
            "telephone_number": "502-361-1197",
            "fax_number": "502-361-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "26812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6426812100",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000050176",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbrockman55376@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "5109 New Cut Rd",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402142745",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "5109 New Cut Rd",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402142745",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.