Elizabeth Brackbill, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD024684E Issued in PA

Practice address

1011 Berk Rd
Leesport, PA 19533-8705

Phone

(610) 376-4841

Fax

(610) 372-6642

NPI assigned

Mar 6, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

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

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.

• Heim Staff Physicians, Inc

  • Geriatric Medicine (Family Medicine) Physician
  • Leesport, PA
  • NPI 1831217314
  Medicare reassignment NPD
• County of Berks Office of the Controller

  • Skilled Nursing Facility
  • Leesport, PA
  • NPI 1053318501
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1720118268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 WYOMISSING BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196102268",
            "telephone_number": "610-378-9449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BERK RD",
            "city": "LEESPORT",
            "state": "PA",
            "postal_code": "195338705",
            "telephone_number": "610-376-4841",
            "fax_number": "610-372-6642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKBILL",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "MD024684E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "MD024684E",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0992727",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Berks Hypnosis and Counseling Services LLC
• Matthew John Blimline, ATC
• Lisa J Bodor
• Courtney Michelle Bottorf, OTR/L
• David W Bowers, MD
• David W Brant, LPC
• David C Brock, MD
• Alexa Nicole Budock, PT, DPT
• Maria B Caba, PTA
• Linda Jean Cambria

• General Practice Physician in Leesport, PA
• Providers in Leesport, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.