Krista M Brucker, MD

Primary specialty

Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X

License

01071924A Issued in IN

Practice address

147 W Green Meadows Dr Ste 2
Greenfield, IN 46140-4000

Phone

(317) 318-0367

NPI assigned

Jun 15, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Preventive MedicineAlso: Emergency Medicine

Education

Harvard Medical School, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Oaklawn Psychiatric Center IncGroup PAC ID 6002801065, 66 clinicians

South Bend Emergency Physicians IncGroup PAC ID 0941282354, 51 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
• Community Hospital of Bremen Inc Hospital, Bremen, IN, CCN 151300

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Oaklawn Psychiatric Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elkhart, IN
  • NPI 1598847212

  IN

  Medicare reassignment Care Compare group NPD
• South Bend Emergency Physicians, Inc

  • Emergency Medicine Physician
  • South Bend, IN
  • NPI 1487132114

  Emergency Medicine, IN

  Medicare reassignment Care Compare group NPD
• Icem-Wishard LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1629304134

  Emergency Medicine, IN

  Medicare reassignment NPD
• Indiana University Health Care Associates, Inc

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1902032832

  IN

  Medicare reassignment NPD
• Oaklawn Psychiatric Center, Inc.

  • Psychiatric Hospital
  • Goshen, IN
  • NPI 1467407395
  Care Compare group NPD
• University Medical Diagnostic Associates, Inc.

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1861441537
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Hospital of Bremen, Inc

  • Critical Access Hospital
  • Bremen, IN
  • NPI 1568417004

  Hospital

  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093

  Hospital

  Care Compare affiliation
• Memorial Hospital of South Bend

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395

  Hospital

  Care Compare affiliation
• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1276560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1497076376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 W GREEN MEADOWS DR STE 2",
            "city": "GREENFIELD",
            "state": "IN",
            "postal_code": "461404000",
            "telephone_number": "317-318-0367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 Lakeview Dr",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465287000",
            "country_code": "US",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCKER",
        "first_name": "KRISTA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-15",
        "last_updated": "2022-06-21",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01071924A",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "IA",
            "license": "MD-49601",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "IN",
            "license": "01071924A",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "IN",
            "license": "01071924A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201212140",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heath A Brooksher, DPT
• Brandon Thomas Brown, BCBA
• Erin Brown, MED
• Jamee Brown
• Rachel Brown
• Erika R Bruggeman, LCSW
• Stephanie Joy Bryan, FNP-C
• Buck Creek Township Hancock County
• Desiree Burnett
• Pamela A Burnett, M.D.

• All providers in Greenfield, IN
• Addiction Medicine (Preventive Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.