Brookside Medical Home Visits LLC
Organization Active NPI Family Nurse Practitioner · Clay City, IN
NPI 1306339742 · NPPES record last updated May 8, 2019
Key facts
- NPI
- 1306339742
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 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
- Organization subpart
- No
Authorized official
- Name
- Shauna E Poe-Ames, CFNP
- Title
- Provider
- Phone
- (812) 229-8707
Corporate family (same tax ID) 1
Practitioners 15
-
Lisa Castor, NP
-
Whitney Lynn Gold, FNP
-
Jennifer J Pence, FNP
-
Kensie Waller, FNP
-
Christine Nicole Poe, ARNP
-
Shauna Elizabeth Poe, FNP-BC
-
Paige E Cisna, NP
-
Jodie R Harper, M.D.
-
Joy Darlene Joyner Pearson, MSN, RN, CFNP
-
Robert Ledda, M.D.
-
Heather Nancy Moon, ARNP
-
Benjamin Scott, FNP
-
Laurel Leligdon, CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN, AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Brookside Medical Home Visits
Locations
1941 W US Highway 40
Brazil, IN 47834
Phone (812) 420-2188
6712 Restoracy Dr
Whitestown, IN 46075
Phone (317) 313-3239
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
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
Other providers in Clay City, IN
- George O. Browne III
- Clay City Pharmacy Thomas H Ridenour
- Ashley Lynn Cothron
- Jamie D Dillon
- Brooke Hall
All providers in Clay City, IN · Family Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.