Individual provider Active NPI

Elviolet Brooks

  • Case Manager/Care Coordinator
  • Jackson, MS
National Provider Identifier
1407039811
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
License
A05888 Issued in MS
Practice address
4548 N State St
Jackson, MS 39206-5335
Phone
(769) 233-3870
NPI assigned
Dec 7, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X A05888 MS Primary

Addresses

Primary practice location

4548 N State St
Jackson, MS 39206-5335

Mailing address

4548 N State St
Jackson, MS 39206-5335
Phone (769) 233-3870

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

State licenses

LicenseStateTypeSpecialty
A05888MSMDCase Manager/Care Coordinator

Practice roles

OrganizationSpecialtyStatusNew patients
Quality Care Sitter, Companion, Homehealth, Hospice Agency L.L.C Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196985600000",
    "number": "1407039811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4548 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065335",
            "telephone_number": "769-233-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4548 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065335",
            "telephone_number": "769-233-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "ELVIOLET",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-07",
        "last_updated": "2007-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "MS",
            "license": "A05888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.