Bethany Marie Brooks, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2021017924 Issued in MO

Practice address

3015 N Ballas Rd
Dept Radiology
Saint Louis, MO 63131-2329

Phone

(314) 996-5170

Fax

(314) 996-4261

NPI assigned

Apr 1, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Missouri Baptist Hospital of SullivanGroup PAC ID 2668380148, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Phelps County Regional Medical Center Hospital, Rolla, MO, CCN 260017

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Missouri Baptist Hospital of Sullivan

  • Critical Access Hospital
  • Sullivan, MO
  • NPI 1295743169
  Medicare reassignment Care Compare group
• Washington University

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1962442475
  Medicare reassignment NPD
• Miracl, LLC

  • Multi-Specialty Clinic/Center
  • Rolla, MO
  • NPI 1205304300
  Medicare reassignment
• Phelps County Regional Medical Center

  • General Acute Care Hospital
  • Rolla, MO
  • NPI 1891766051
  Medicare reassignment
• Missouri Baptist Hospital of Sullivan

  • Rural Health Clinic/Center
  • Sullivan, MO
  • NPI 1235228222
  NPD
• Missouri Baptist Hospital of Sullivan

  • Ambulance
  • Sullivan, MO
  • NPI 1831343268
  NPD
• Phelps County Regional Medical Center

  • Rural Health Clinic/Center
  • Salem, MO
  • NPI 1194077701
  NPD
• Phelps County Regional Medical Center

  • Rural Health Clinic/Center
  • Rolla, MO
  • NPI 1366066037
  NPD

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

• Phelps County Regional Medical Center

  • Rural Health Clinic/Center
  • Salem, MO
  • NPI 1194077701

  Hospital

  Care Compare affiliation
• Phelps County Regional Medical Center

  • Rehabilitation Hospital Unit
  • Rolla, MO
  • NPI 1346287455
  Care Compare affiliation
• Phelps County Regional Medical Center

  • General Acute Care Hospital
  • Rolla, MO
  • NPI 1891766051
  Care Compare affiliation

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746144000000",
    "number": "1760060586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-996-5170",
            "fax_number": "314-996-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 N BALLAS RD",
            "address_2": "DEPT RADIOLOGY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312329",
            "telephone_number": "314-996-5170",
            "fax_number": "314-996-4261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-458-8899",
            "fax_number": "573-341-5611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "BETHANY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-01",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2021017924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220097215",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "3015 N Ballas Rd",
            "address_2": "Dept Radiology",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631312329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert W Brooker, MD
• Albert Dennis Brooks, MD
• Allison Machele Brooks, OTR/L
• Amie D Brooks, PHARM.D.
• Ashton Jean Brooks, MD
• Betsy Brooks
• Cedric Ladarryl Brooks
• Chloe R Brooks
• Christopher B Brooks, MD
• Delora M Brooks, FNP-BC

• Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2025; 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.