NPIMap

Individual provider Active NPI

Bruce Earl Brockstein, MD

  • Medical Oncology Physician
  • Evanston, IL
National Provider Identifier
1740349695
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
036086058 Issued in IL
Practice address
2650 Ridge Ave
Kellogg Cancer Center
Evanston, IL 60201
Phone
(847) 570-2112
Fax
(847) 570-1041
NPI assigned
Dec 7, 2006
Last updated
Oct 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 036086058 IL Primary

Addresses

Primary practice location

2650 Ridge Ave
Kellogg Cancer Center
Evanston, IL 60201

Mailing address

2650 Ridge Ave
Kellogg Cancer Center
Evanston, IL 60201-1718
Phone (847) 570-2112

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bbrockstein9806@direct.northshore.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050825000788 IL Practitioner - Medical OncologyPractitioner - Hematology/Oncology 3072544410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
University of Chicago, Pritzker School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

757 Park Ave W
Highland Park, IL 60035-2558

777 Park Ave W
Highland Park, IL 60035-2433

800 W Central Rd
Arlington Heights, IL 60005-2349
Phone (847) 618-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Sep 1, 1999 Accepting new patients
Endeavor Health Medical Group CurrentSince Sep 1, 1999 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

Interoperability endpoints

  • Direct secure messaging: bbrockstein9806@direct.northshore.org

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1740349695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "KELLOGG CANCER CENTER",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2112",
            "fax_number": "847-570-1041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "KELLOGG CANCER CENTER",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-570-2112",
            "fax_number": "847-570-1041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKSTEIN",
        "first_name": "BRUCE",
        "middle_name": "EARL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-07",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "IL",
            "license": "036086058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bbrockstein9806@direct.northshore.org",
            "affiliation": "N",
            "address_1": "2650 Ridge Ave",
            "address_2": "Kellogg Cancer Center",
            "city": "Evanston",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.