Tatiana Zupekan Brinckerhoff, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD211003 Issued in OR

Practice address

777 NW 9TH St Ste 320
Corvallis, OR 97330-6169

Phone

(541) 768-4900

NPI assigned

Apr 21, 2015

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 1

Electronic endpoints 1

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: 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: tbrinckerhoff239328@samhealth.direct-ci.com
• Direct secure messaging: tbrinckerhoff203141@direct.myadvocateaurora.org

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.

• Good Samaritan Hospital Corvallis

  • General Acute Care Hospital
  • Corvallis, OR
  • NPI 1962453134
  Medicare reassignment NPD
• Good Samaritan Hospital Corvallis

  • Gynecologic Oncology Physician
  • Corvallis, OR
  • NPI 1710787916
  NPD

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1578950291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 NW 9TH ST STE 320",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306169",
            "telephone_number": "541-768-4900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2714 Riverview Dr",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543136715",
            "country_code": "US",
            "telephone_number": "920-430-4760",
            "fax_number": "920-430-4774",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "555 Redbird Cir Ste 200",
            "address_purpose": "LOCATION",
            "city": "DE Pere",
            "state": "WI",
            "postal_code": "541157979",
            "country_code": "US",
            "telephone_number": "920-338-6820",
            "fax_number": "920-338-6829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRINCKERHOFF",
        "first_name": "TATIANA",
        "middle_name": "ZUPEKAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-21",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "69696",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD211003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080735",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tbrinckerhoff239328@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "777 NW 9th St Ste 320",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973306169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristopher Erik Briggs
• Bright Star Lactation
• Robert Ora Bright
• Brighter Day Cosmetic and Reconstructive Surgery, LLC
• Shannon G Brimhill
• Aimee Victoria Brink, CADC 1, QMHA
• Isabella Marie Brinkmann
• Brock Ryan Bristow
• Christopher Broadbent, LPC
• Catherine Broadhurst, SLP

• Pediatrics Physician in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Pediatrics Physician in Oregon

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