Active NPI
Brooke Ball, CNA
- Attendant Care Provider
- Poplar Grove, IL
National Provider Identifier
1366063539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- Practice address
- 203 Constitution Dr SW # B
Poplar Grove, IL 61065-8729 - Phone
- (815) 355-5369
- NPI assigned
- Apr 29, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Care Agency | 251J00000X | |||
| Attendant Care Provider | 3747A0650X | Primary |
Addresses
Primary practice location
203 Constitution Dr SW # B
Poplar Grove, IL 61065-8729
Mailing address
203 Constitution Dr SW # B
Poplar Grove, IL 61065-8729
Other practice location 1
4919 Rolex Pkwy
Loves Park, IL 61111-6223
Phone (815) 355-5369
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | NONE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | BrookeBall94@icloud.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588118400000",
"number": "1366063539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 CONSTITUTION DR SW # B",
"city": "POPLAR GROVE",
"state": "IL",
"postal_code": "610658729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 CONSTITUTION DR SW # B",
"city": "POPLAR GROVE",
"state": "IL",
"postal_code": "610658729",
"telephone_number": "815-355-5369"
}
],
"practiceLocations": [
{
"address_1": "4919 Rolex Pkwy",
"address_purpose": "LOCATION",
"city": "Loves Park",
"state": "IL",
"postal_code": "611116223",
"country_code": "US",
"telephone_number": "815-355-5369",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BALL",
"first_name": "BROOKE",
"credential": "CNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-29",
"last_updated": "2020-04-29",
"certification_date": "2020-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "NONE",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "BrookeBall94@icloud.com",
"affiliation": "N",
"address_1": "4919 Rolex Pkwy",
"city": "Loves Park",
"state": "IL",
"country_code": "US",
"postal_code": "611116223",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Poplar Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.