Sumner L Brooks, MPH, RD, CSSD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD-D-10169435 Issued in OR

Practice address

1111 NE 99TH Ave
Suite 301
Portland, OR 97220-9428

Phone

(503) 963-2707

Fax

(503) 963-2802

NPI assigned

Aug 23, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1477833390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322684",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 NE 99TH AVE",
            "address_2": "SUITE 301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209428",
            "telephone_number": "503-963-2707",
            "fax_number": "503-963-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "SUMNER",
        "middle_name": "L",
        "credential": "MPH, RD, CSSD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-23",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "987508",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LD-D-10169435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2065312",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500714219",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Koren Brooks
• Lindsay Brooks, PTA, PA-C
• Mary Christine Brooks, MD
• Rachel Ellen Brooks, M.D.
• Sheri Lynn Brooks, ABOC,COA,RA
• Sydni Brooks
• Tina Ann Brooks, SLP
• Toby Brooks
• Craig Gerald Brooksby, MD
• Brookside Dental-Sellwood, LLC

• Registered Dietitian in Portland, OR
• Providers in Portland, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; 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.