Kelli Brockman

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2015011883 Issued in MO

Practice address

255 Boderman
Bloomsdale, MO 63627-9099

Phone

(573) 483-9492

NPI assigned

Jul 5, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellibrockman@mhccaremail.com

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.

• Ste Genevieve County Memorial Hospital

  • Critical Access Hospital
  • Ste Genevieve, MO
  • NPI 1073587655
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  • Rural Health Clinic/Center
  • Bloomsdale, MO
  • NPI 1184658387
  Medicare reassignment NPD
• Ste. Genevieve County Memorial Hospital

  • Foot Surgery Podiatrist
  • Bloomsdale, MO
  • NPI 1104692946
  NPD

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

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1477818599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 BODERMAN",
            "city": "BLOOMSDALE",
            "state": "MO",
            "postal_code": "636279099",
            "telephone_number": "573-483-9492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 BODERMAN",
            "city": "BLOOMSDALE",
            "state": "MO",
            "postal_code": "636279099",
            "telephone_number": "573-483-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "KELLI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-05",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2015011883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Assaf, DO
• Jonathon M Bird, MD
• Theresa A Cavins, M.D.
• Meagan Anne Conwell, CNP, PNP-PC
• Mary Elizabeth Crecelius, WHNP
• Day Seven Medical LLC
• Drury Chiropractic and Family Wellness LLC

• Pediatrics Physician in Bloomsdale, MO
• Providers in Bloomsdale, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.