Tara Ann Brockman, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4351035205 Issued in MI

Practice address

300 68TH St SE
Grand Rapids, MI 49548-6927

Phone

(616) 456-0842

Fax

(616) 559-5864

NPI assigned

Apr 18, 2018

Last updated

Feb 3, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Psychiatry

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

State of Michigan Office of Financial ManagementGroup PAC ID 5496650723, 22 clinicians

Practice addresses (Care Compare)

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.

• State of Michigan Office of Financial Management

  dba State of Michigan

  • Psychiatric Hospital
  • Westland, MI
  • NPI 1508883299
  Medicare reassignment Care Compare group NPD
• Community Mental Health for Central Michigan

  • Psychiatry Physician
  • Mt Pleasant, MI
  • NPI 1881622892
  Medicare reassignment
• State of Michigan Office of Financial Management

  dba Kalamazoo Psychiatric Hospital

  • Psychiatric Hospital
  • Kalamazoo, MI
  • NPI 1194736587
  NPD
• State of Michigan Office of Financial Management

  dba Michigan Veteran Homes at Chesterfield Twp

  • Skilled Nursing Facility
  • Chesterfield, MI
  • NPI 1497342653
  NPD
• Community Mental Health for Central Michigan

  • Psychiatry Physician
  • Mt Pleasant, MI
  • NPI 1609412840
  NPD (past)

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

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1346737913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-456-0842",
            "fax_number": "616-559-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-456-0842",
            "fax_number": "616-559-5864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "TARA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-18",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301114533",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4351035205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Scott Britton
• Taju Brmajji
• Eric Broadworth
• Ardean Beth Brock-Vanderwall, M.DIV., M.A.
• Megan Brock, LLMSW
• Kaelee Sara Brockway, PT, DPT, GCS, CEEAA
• Danielle K Brodberg, AT, ATC
• Cassandra Broden
• Jerome Daniel Broderick, P.T.
• Jacqueline Broders, PT, DPT

• Psychiatry Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.