Lauren Shaw Brock, CRNP
Individual provider Active NPI Family Nurse Practitioner · Northport, AL
NPI 1427435643 · NPPES record last updated Jan 31, 2022
Key facts
- NPI
- 1427435643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1-131700 (AL)
- Practice address
- 4280 Watermelon Rd Ste 110
Northport, AL 35473-5250 - Phone
- (205) 710-3838
- Fax
- (205) 710-3839
- NPI assigned
- Apr 27, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dutch Medical Clinics, Inc
Practice addresses (Care Compare)
4508 Hwy 45 N
Columbus, MS 39705-2917
Phone (662) 329-9702
Hospital & facility affiliations
- Mississippi Homecare of Eupora
- BMH-Golden Triangle
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL, MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150717000680 | AL | Practitioner - Nurse Practitioner | 3375856511 | |
| I20220712000066 | MS | Practitioner - Nurse Practitioner | 3375856511 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dutch Medical Clinics, Inc | Current |
Accepting new patients | |
| Dutch Medical Clinics, Inc. | Family | Past | Accepting new patients |
Locations
4508 Highway 45 N
Columbus, MS 39705
Phone (662) 328-9702
3654B New Hope Rd
Columbus, MS 39702
Phone (662) 329-1488
56 Dutch Ln
Columbus, MS 39702
Phone (662) 329-3808
Interoperability endpoints
- lauren.brock.1@24945.direct.athenahealth.com
- lauren.brock.1@17762.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1-131700 | AL | Yes |
Addresses
Primary practice location
4280 Watermelon Rd Ste 110
Northport, AL 35473-5250
Mailing address
4280 Watermelon Rd Ste 110
Northport, AL 35473-5250
Phone (205) 710-3838
Other providers in Northport, AL
- Robert Meaders Bragg
- Normekia Braggs
- Lisa Brashier
- Tammy Brazeal
- Bright Horizons Family Resource Center, LLC.
- David Charles Brooks
- Anna Jane Brown
- Daryl Palmer Brown
- Evonne R Brown
- Karen Brown
All providers in Northport, AL · Family Nurse Practitioner in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.