NPIMap

Individual provider Active NPI

Nicole Brokloff

  • Family Medicine Physician
  • Bettendorf, IA
National Provider Identifier
1285085704
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R-10697 Issued in IA
Practice address
2140 53Rd Ave
Bettendorf, IA 52722-6279
Phone
(563) 421-5700
Fax
(563) 421-5700
NPI assigned
Jun 27, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R-10697 IA Primary

Addresses

Primary practice location

2140 53Rd Ave
Bettendorf, IA 52722-6279

Mailing address

2140 53Rd Ave
Bettendorf, IA 52722-6279
Phone (563) 421-5700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nicole.brokloff@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20190911002790 IA Practitioner - Family Practice 3476847211 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quad Cities Primary Care LLCGroup PAC ID 2961800933, 2 clinicians

Practice addresses (Care Compare)

3385 Dexter CT
Suite 105
Davenport, IA 52807-3471
Phone (563) 551-3800

Hospital & facility affiliations

  • Mercyone Genesis Hospice, Bettendorf, IA, CCN 161520
  • Trinity Rock Island Hospital, Rock Island, IL, CCN 140280
  • Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033
  • Trinity - Bettendorf Hospital, Bettendorf, IA, CCN 160104
  • Genesis HLTH System Dba Genesis MDL Ctr-Illini Hospital, Silvis, IL, CCN 140275

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-10697IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System Family Medicine CurrentSince Sep 9, 2019 Accepting new patients
Genesis Health System CurrentSince Sep 9, 2019 Accepting new patients
Quad Cities Primary Care, LLC Family Medicine CurrentSince Jan 6, 2025 Accepting new patients

Locations

2140 53rd Ave
Bettendorf, IA 52722
Phone (563) 421-5700

210 W 53rd St
Davenport, IA 52806
Phone (563) 386-3436

1345 W Central Park Ave
Davenport, IA 52804
Phone (563) 421-4400

3385 Dexter Ct
Ste 105
Davenport, IA 52807
Phone (563) 323-1352

619 5th St
Durant, IA 52747
Phone (563) 785-4487

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCFFCD
  • FHIR API: https://fhir4.healow.com/fhir/r4/GCFFCD/Endpoint/GCFFCD
  • Direct secure messaging: nicole.brokloff@direct.genesishealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619740800000",
    "number": "1285085704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 53RD AVE",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527226279",
            "telephone_number": "563-421-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 53RD AVE",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527226279",
            "telephone_number": "563-421-5700",
            "fax_number": "563-421-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKLOFF",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-27",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R-10697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicole.brokloff@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "2140 53rd Ave",
            "city": "Bettendorf",
            "state": "IA",
            "country_code": "US",
            "postal_code": "527226279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bettendorf, IA

Sources for this page

Verify at the official NPI Registry.