Individual provider Active NPI

Kimberly Dawn Brooks, FNP

  • Family Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1780064923
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19500 Issued in SC
Practice address
209 Three Bridges Rd
Greenville, SC 29611-7549
Phone
(864) 522-5500
Fax
(864) 241-9207
NPI assigned
Jun 3, 2015
Last updated
May 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 19500 SC Primary

Addresses

Primary practice location

209 Three Bridges Rd
Greenville, SC 29611-7549

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other identifiers 1

IdentifierTypeStateIssuer
NP3624MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbrooks44230@direct.ghs.myhfn.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20160129001498 SC Practitioner - Nurse Practitioner 9234431354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.33 of 100Reported as group
Quality
75.48
Promoting interoperability
100
Improvement activities
40
Cost
72.29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19500SCMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Jan 4, 2016 Accepting new patients
Prisma Health University Medical Group CurrentSince Jan 4, 2016 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

209 Three Bridges Rd
Greenville, SC 29611
Phone (864) 220-4209

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

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.

NPI Registry JSON

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

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1780064923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 THREE BRIDGES RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296117549",
            "telephone_number": "864-522-5500",
            "fax_number": "864-241-9207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-03",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP3624",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbrooks44230@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kbrooks44230@direct.ghs.myhfn.org",
            "address_1": "209 Three Bridges Rd",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296117549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.