Stephen Russell Brooks, NAVY IDC

Primary specialty

TechnicianTaxonomy code 374700000X

License

1163448811 Issued in VA

Practice address

472 Polaris St BLDG 586
Virginia Beach, VA 23461-1935

Phone

(910) 741-9612

NPI assigned

Mar 27, 2022

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1648339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648339200000",
    "number": "1780334276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "472 POLARIS ST BLDG 586",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234611935",
            "telephone_number": "910-741-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "472 POLARIS ST BLDG 586",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234611935",
            "telephone_number": "910-741-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "STEPHEN",
        "middle_name": "RUSSELL",
        "name_prefix": "Mr.",
        "credential": "NAVY IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-27",
        "last_updated": "2022-03-27",
        "certification_date": "2022-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374700000X",
            "taxonomy_group": "",
            "desc": "Technician",
            "state": "VA",
            "license": "1163448811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED STATES NAVY",
            "identifier": "1163448811",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stephen.brooks.mil@socom.mil",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "472 Polaris St Bldg 586",
            "city": "Virginia Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234611935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Infinity Alexandria Brooks, MA, CSAC-S, LPC-R
• Kevin Eugene Brooks, M.D. M.P.H.
• Krystal R Brooks
• Lagora A. Oliver Brooks, MD
• Shakirrah Monet Brooks, RBT
• Valerie Brooks
• Brookside Psychiatric Specialists PLLC
• Mackenzie Ellen Broom
• Jesse Michael Broome, M.D.
• Jasmine Brothers

• Technician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.