Individual provider Active NPI

Brett Schupack, DO

  • Emergency Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1780035139
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036163454 Issued in IL
Practice address
506 6TH St
Department of Emergency Medicine
Brooklyn, NY 11215-3609
Phone
(718) 780-5040
NPI assigned
Jun 27, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2020014926 MO
Emergency Medicine Physician 207P00000X 298861 NY
Emergency Medicine Physician 207P00000X 036163454 IL Primary

Addresses

Primary practice location

506 6TH St
Department of Emergency Medicine
Brooklyn, NY 11215-3609

Mailing address

506 6TH St
Department of Emergency Medicine
Brooklyn, NY 11215-3609
Phone (718) 780-5040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MO, IL3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20190701002165 NY Practitioner - Emergency Medicine 4183958713
I20200629000398 MO Practitioner - Emergency Medicine 4183958713 Reassigns benefits to 2 organizations
I20230220001803 IL Practitioner - Emergency Medicine 4183958713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Touro Un Col of Osteopathic Medicine, New York, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sikeston Emergency Group LLCGroup PAC ID 6305112814, 19 clinicians
Cep America LLCGroup PAC ID 6608056171, 995 clinicians
Cepamerica Illinois LLPGroup PAC ID 3274793633, 492 clinicians

Practice addresses (Care Compare)

1008 N Main St
Sikeston, MO 63801-5044
Phone (573) 471-1600

12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 344-6000

503 N Maple St
Effingham, IL 62401-2006
Phone (217) 347-1211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.41 of 100Reported as group
Quality
86.81
Improvement activities
40
Cost
77.34

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as group
Quality
65.2
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020014926MOMDEmergency Medicine Physician
298861NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP Emergency Medicine Current Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Jul 1, 2020 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Feb 7, 2023 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Jul 1, 2020 Accepting new patients
Cep America, LLC Emergency Medicine Current Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Feb 7, 2023 Accepting new patients
Sikeston Emergency Group LLC Emergency Medicine CurrentSince Aug 22, 2023 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

503 N Maple St
Effingham, IL 62401
Phone (217) 342-2121

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

12303 De Paul Dr
Bridgeton, MO 63044
Phone (314) 344-6360

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

1008 N Main St
Sikeston, MO 63801
Phone (573) 471-1600

Organizations & group practices 7

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 4

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": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1780035139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 6TH ST",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112153609",
            "telephone_number": "718-780-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 6TH ST",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112153609",
            "telephone_number": "718-780-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUPACK",
        "first_name": "BRETT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-27",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2020014926",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "298861",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036163454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.