NPIMap

Individual provider Active NPI

Andrew Trueman Brockenbrough, MD

  • Nephrology Physician
  • Kent, WA
National Provider Identifier
1316994288
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD00039138 Issued in WA
Practice address
24920 104TH Ave SE
Kent, WA 98030-6443
Phone
(425) 690-3544
Fax
(425) 690-9444
NPI assigned
May 27, 2006
Last updated
Aug 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MD00039138 WA Primary

Addresses

Primary practice location

24920 104TH Ave SE
Kent, WA 98030-6443

Mailing address

3600 Lind Ave SW
Ste 100
Renton, WA 98057-4934
Phone (425) 656-5412

Other identifiers 1

IdentifierTypeStateIssuer
1007639MedicaidWA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address abrockenbrough12649@direct.valleymed.org Direct
FHIR URL https://FHIR.valleymed.org/FHIR-PRD/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20061030000160 WA Practitioner - Nephrology 6002857430 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Vanderbilt University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

Practice addresses (Care Compare)

24920 104TH Ave SE
Kent, WA 98030-6443
Phone (253) 395-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00039138WAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Medical Group-Renton Family Medicine CurrentSince May 15, 2010 Accepting new patients
Northwest Kidney Centers PastSince Jul 1, 2015 Accepting new patients
Public Hospital District #1 of King County Past Accepting new patients

Locations

16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971

24920 104th Ave SE
Kent, WA 98030
Phone (253) 395-1985

3600 Lind Ave SW
Ste 100
Renton, WA 98057

4033 Talbot Rd S
Ste 430
Renton, WA 98055
Phone (425) 227-0231

4033 Talbot Rd S
Ste 570
Renton, WA 98055
Phone (425) 656-5400

Interoperability endpoints

  • Direct secure messaging: abrockenbrough12649@direct.valleymed.org

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1316994288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 LIND AVE SW",
            "address_2": "STE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574934",
            "telephone_number": "425-656-5412",
            "fax_number": "425-656-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24920 104TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306443",
            "telephone_number": "425-690-3544",
            "fax_number": "425-690-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKENBROUGH",
        "first_name": "ANDREW",
        "middle_name": "TRUEMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WA",
            "license": "MD00039138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007639",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abrockenbrough12649@direct.valleymed.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "abrockenbrough12649@direct.valleymed.org",
            "address_1": "24920 104th Ave SE",
            "city": "Kent",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980306443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://FHIR.valleymed.org/FHIR-PRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "24920 104th Ave SE",
            "city": "Kent",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980306443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

Verify at the official NPI Registry.