Active NPI
Brooke Reavis
- Nurse Practitioner
- Salem, OR
National Provider Identifier
1487333928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 10010750
- Practice address
- 1015 3Rd St NW
Salem, OR 97304-4007 - Phone
- (503) 588-3600
- NPI assigned
- Jul 12, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 10010750 | OR | Primary |
Addresses
Primary practice location
1015 3Rd St NW
Salem, OR 97304-4007
Mailing address
1015 3Rd St NW
Salem, OR 97304-4007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10010750 | OR | MD | Nurse Practitioner |
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.
-
- Community Based Hospice Care Agency
- Salem, OR
- NPI 1093715070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689552000000",
"number": "1487333928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 3RD ST NW",
"city": "SALEM",
"state": "OR",
"postal_code": "973044007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 3RD ST NW",
"city": "SALEM",
"state": "OR",
"postal_code": "973044007",
"telephone_number": "503-588-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAVIS",
"first_name": "BROOKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-12",
"last_updated": "2023-07-17",
"certification_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OR",
"license": "10010750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.