NPIMap

Individual provider Active NPI

Jackie Kevin Brooks, M.D.

  • Orthopaedic Surgery Physician
  • Brunswick, GA
National Provider Identifier
1366430233
Registry record updated Aug 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
052148 Issued in GA
Practice address
3231 Glynn Ave
Brunswick, GA 31520-4851
Phone
(912) 265-9006
Fax
(912) 265-7200
NPI assigned
Oct 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 052148 GA Primary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 052148 GA

Addresses

Primary practice location

3231 Glynn Ave
Brunswick, GA 31520-4851

Mailing address

3231 Glynn Ave
Brunswick, GA 31520-4851
Phone (912) 265-9006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20040702000079 GA Practitioner - Orthopedic Surgery 9830176346 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Medical College of Georgia School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Effingham Rehab Services, LLCGroup PAC ID 5597752063, shared by 3 NPIs, 143 clinicians
Optim Orthopedics LLCGroup PAC ID 9931427002, 101 clinicians

Practice addresses (Care Compare)

1390 Boone Ave Ext
Suite A23
Kingsland, GA 31548-6515
Phone (419) 221-3717

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

3231 Glynn Ave
Brunswick, GA 31520-4851
Phone (912) 342-7112

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Waycross, GA, CCN 117076
  • Advantage Home Health Home health agency, Brunswick, GA, CCN 117088
  • Southeast Georgia Health System- Brunswick Campus Hospital, Brunswick, GA, CCN 110025

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement38
Knee replacement77
Lower limb (leg) arthroscopy (minimally invasive joint repair)29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
052148GAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optim Orthopedics, LLC Orthopaedic Surgery CurrentSince Nov 1, 2024 Accepting new patients
Optim Orthopedics, LLC Orthopaedic Surgery CurrentSince Nov 1, 2024 Accepting new patients
Southern Orthopaedics and Sports Medicine, P.C. Orthopaedic Surgery CurrentSince Jun 4, 2004 Accepting new patients
Optim Orthopedics, LLC Orthopaedic Surgery PastSince Oct 6, 2019 Accepting new patients
Cooperative Healthcare Services Inc Orthopaedic Surgery Past Accepting new patients
Optim Orthopedics, LLC Orthopaedic Surgery Past Accepting new patients
Southeast Georgia Health System, Inc. Past Accepting new patients

Locations

3231 Glynn Ave
Brunswick, GA 31520
Phone (912) 265-9006

210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140

Interoperability endpoints

  • Direct secure messaging: jackie.brooks.1@16403.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186617600000",
    "number": "1366430233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 GLYNN AVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204851",
            "telephone_number": "912-265-9006",
            "fax_number": "912-265-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 GLYNN AVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204851",
            "telephone_number": "912-265-9006",
            "fax_number": "912-265-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "JACKIE",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2007-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "052148",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "GA",
            "license": "052148",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

Verify at the official NPI Registry.