Nancy Brockington, MD
Individual provider Active NPI Family Medicine Physician · Willow Creek, CA
NPI 1629119334 · NPPES record last updated Apr 19, 2019
Key facts
- NPI
- 1629119334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G69128 (CA)
- Practice address
- 38883 Hwy 299
Willow Creek, CA 95573 - Phone
- (530) 629-3111
- NPI assigned
- Feb 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of California, Davis School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Open Door Community Health Centers
Practice addresses (Care Compare)
38883 Hwy 299
Willow Creek, CA 95573-0726
Phone (530) 629-3111
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091130000073 | CA | Practitioner - Family Practice | 1759420052 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G69128 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients |
Locations
1275 8th St
Arcata, CA 95521
770 10th St
Arcata, CA 95521
Phone (707) 826-8610
2200 Tydd St
Eureka, CA 95501
Phone (707) 269-7051
670 9th St
Ste 203
McKinleyville, CA 95521
Interoperability endpoints
- nbrockington12175@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G69128 | CA | Yes |
Addresses
Primary practice location
38883 Hwy 299
Willow Creek, CA 95573
Mailing address
670 9TH St
Suite 203
Arcata, CA 95521-6248
Phone (707) 826-8633
Other providers in Willow Creek, CA
- Norman Bensky
- Brian Bottemiller
- Lanesha Bracy
- Aileen Burns
- Lamont Damon
- Jerome Michael Decapua
- Laura Denight
- Lexi M Doolittle
All providers in Willow Creek, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.