NPIMap

Organization Active NPI

Brookside Medical Home Visits LLC

  • Family Nurse Practitioner
  • Clay City, IN
National Provider Identifier
1306339742
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
BROOKSIDE MEDICAL HOME VISITS LLC
Practice address
265 W County Road 850 S
Clay City, IN 47841-8210
Phone
(812) 229-8707
Fax
(812) 442-2781
NPI assigned
Jun 11, 2018
Last updated
May 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Authorized official

Name
Shauna E Poe-Ames, CFNP
Title
Provider
Phone
(812) 229-8707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

265 W County Road 850 S
Clay City, IN 47841-8210

Mailing address

265 W County Road 850 S
Clay City, IN 47841-8210
Phone (812) 229-8707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190408002379 IN Part B Supplier - Clinic/Group Practice 8325389984 Receives reassigned benefits from 12 practitioners
Practice locations: Clay City, IN
O20230711003647 AK Part B Supplier - Clinic/Group Practice 8325389984 Receives reassigned benefits from 2 practitioners
Practice locations: Soldotna, AK

National Provider Directory

National Provider Directory
Tax ID family
Brookside Medical Home Visits2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1941 W US Highway 40
Brazil, IN 47834
Phone (812) 420-2188

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557273600000",
    "number": "1306339742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 W COUNTY ROAD 850 S",
            "city": "CLAY CITY",
            "state": "IN",
            "postal_code": "478418210",
            "telephone_number": "812-229-8707",
            "fax_number": "812-442-2781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 W COUNTY ROAD 850 S",
            "city": "CLAY CITY",
            "state": "IN",
            "postal_code": "478418210",
            "telephone_number": "812-229-8707",
            "fax_number": "812-442-2781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE MEDICAL HOME VISITS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2019-05-08",
        "status": "A",
        "authorized_official_last_name": "POE-AMES",
        "authorized_official_first_name": "SHAUNA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "812-229-8707",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clay City, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.