Cornelius Paul Brooke, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

5809M Issued in ID

Practice address

2001 S Woodruff Ave
Ste 12a
Idaho Falls, ID 83404-6374

Phone

(208) 522-8945

Fax

(208) 522-5374

NPI assigned

Jan 27, 2006

Last updated

Jul 5, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of Colorado School of Medicine, Denver, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Merit-based Incentive Payment System (MIPS)

Final score

91.67 of 100Reported as individual

Quality

83.33

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Idaho Falls Dermatology P a

  • Specialist
  • Idaho Falls, ID
  • NPI 1487700464
  Medicare reassignment NPD Authorized official
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Medicare reassignment Care Compare group

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

• Eastern Idaho Health Services Inc

  dba Eastern Idaho Regional Medical Center

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467676800000",
    "number": "1275504300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE",
            "address_2": "STE 12A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046374",
            "telephone_number": "208-522-8945",
            "fax_number": "208-522-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE",
            "address_2": "STE 12A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046374",
            "telephone_number": "208-522-8945",
            "fax_number": "208-522-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKE",
        "first_name": "CORNELIUS",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2016-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "5809M",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "58099",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002685200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "77186",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Brizzee
• Broadway Smiles (Signature Smiles)
• Anne L Broadway, M.D.
• Brodi Smith DO PLLC (Idaho Falls Surgical Specialists)
• Carrie Bronson
• Broulim Supermarkets, LLC (Broulim's Pharmacy #16 - Broadway)
• Jamie Renee Brower, PHARM, D
• David Kelly Brown, DO
• James D Brown, FNP-C
• Kellie J Brown, LCSW

• Dermatology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.