Brooke Lael Corcoran, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7704 Issued in WI

Practice address

2360 Duck Creek Pkwy
Green Bay, WI 54303-3300

Phone

(920) 965-0345

NPI assigned

Nov 21, 2023

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 names 1

• Brooke Lael Tompkins Former name

Medicare fee-for-service enrollment

Enrolled in MI, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Lincoln Memorial University Medical Department, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New Dermatology Group LTDGroup PAC ID 9537312665, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: brooke.corcoran.1@23194.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New Dermatology Group LTD

  • Dermatology Physician
  • Howard, WI
  • NPI 1235480112

  MI

  Medicare reassignment Care Compare group
• New Dermatology Group LTD

  • Dermatology Physician
  • Iron Mountain, MI
  • NPI 1710321633
  NPD (past)

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

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1689449522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4016 KIRKSVILLE RD",
            "city": "LANCASTER",
            "state": "KY",
            "postal_code": "404448659",
            "telephone_number": "859-358-5612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 DUCK CREEK PKWY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033300",
            "telephone_number": "920-965-0345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1606 S Stephenson Ave",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498013636",
            "country_code": "US",
            "telephone_number": "920-965-0345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORCORAN",
        "first_name": "BROOKE",
        "middle_name": "LAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-21",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7704",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012169",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "TOMPKINS",
            "middle_name": "LAEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicholas Edward Coorough, M.D.
• Vicky Coppens, CAPSW
• Marissa Lee Coppersmith, NP
• Sarah M Coppin, DPT
• Kamie Marie Corbiere Swanson, OT
• Adam John Cordova II, PT
• Alyssa C Cormier, OTR/L
• Torland E Cornelius-Adkins, LCSW
• Penny S Cornelius, PA
• Victoria L Cornelius

• Physician Assistant in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.
• 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.