Individual provider Active NPI

Brooke Erin Vasicek, M.D.

  • Dermatology Physician
  • Rockford, MI
National Provider Identifier
1619326550
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4301501553 Issued in MI
Practice address
6150 Northland Drive
Rockford, MI 49341
Phone
(616) 942-9343
Fax
(616) 942-2538
NPI assigned
Jun 10, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 4301501553 MI Primary

Addresses

Primary practice location

6150 Northland Drive
Rockford, MI 49341

Mailing address

6150 Northland Drive
Rockford, MI 49341
Phone (616) 942-9343

Other practice location 1

3434 Rivertown Point Ct SW
Grandville, MI 49418-3076
Phone (616) 257-3344

Other practice location 2

3290 N Wellness Dr Ste 240
Holland, MI 49424-7261
Phone (616) 395-9379

Other names 1

  • Dr. Brooke Erin Boer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20200616001867 MI Practitioner - Dermatology 8022388107 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Michigan State University College of Human Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jack a Dekkinga MD PCGroup PAC ID 3375538432, 20 clinicians

Practice addresses (Care Compare)

750 E Beltline Ave NE
Suite 301
Grand Rapids, MI 49525-6046
Phone 61694293431207

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision16
Removal of skin lesions388
Removal or shaving of skin growth1-10
Skin biopsy224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301501553MIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jack a Dekkinga MD PC Dermatology CurrentSince Aug 1, 2020 Accepting new patients

Locations

750 E Beltline Ave NE
Ste 301
Grand Rapids, MI 49525
Phone (616) 913-0138

3434 Rivertown Point Ct SW
Grandville, MI 49418
Phone (616) 257-3344

3290 N Wellness Dr
Ste 240
Holland, MI 49424
Phone (616) 395-9379

6150 Northland Dr NE
Rockford, MI 49341
Phone (616) 942-9343

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1619326550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6150 NORTHLAND DRIVE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-942-9343",
            "fax_number": "616-942-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6150 NORTHLAND DRIVE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-942-9343",
            "fax_number": "616-942-2538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3434 Rivertown Point Ct SW",
            "address_purpose": "LOCATION",
            "city": "Grandville",
            "state": "MI",
            "postal_code": "494183076",
            "country_code": "US",
            "telephone_number": "616-257-3344",
            "fax_number": "616-257-1491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3290 N Wellness Dr Ste 240",
            "address_purpose": "LOCATION",
            "city": "Holland",
            "state": "MI",
            "postal_code": "494247261",
            "country_code": "US",
            "telephone_number": "616-395-9379",
            "fax_number": "616-820-1457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASICEK",
        "first_name": "BROOKE",
        "middle_name": "ERIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-10",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301501553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "BOER",
            "middle_name": "ERIN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rockford, MI

Sources for this page

Verify at the official NPI Registry.