Kristin M. Brock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3832 Issued in OK

Practice address

122 E Grand Ave
Ponca City, OK 74601-5205

Phone

(580) 302-8270

Fax

(580) 749-5682

NPI assigned

Jul 5, 2012

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 2

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairfax Medical Facilities IncGroup PAC ID 4284663360, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kristin.brock@fmf.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/AGHIAA

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.

• Fairfax Medical Facilities Inc

  • Federally Qualified Health Center (FQHC)
  • Fairfax, OK
  • NPI 1538183173

  OK

  Medicare reassignment Care Compare group NPD
• Community Pathways Unlimited Inc

  • Clinical Psychologist
  • Oklahoma City, OK
  • NPI 1659328284

  OK

  Medicare reassignment NPD
• Fairfax Medical Facilities, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ponca City, OK
  • NPI 1316747017
  Care Compare group NPD
• Fairfax Medical Facilities Inc

  • Federally Qualified Health Center (FQHC)
  • Hominy, OK
  • NPI 1609040864
  Care Compare group NPD (past)
• Fairfax Medical Facilities Inc

  • Federally Qualified Health Center (FQHC)
  • Newkirk, OK
  • NPI 1851535785
  Care Compare group NPD (past)

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

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1780949883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N MAIN ST",
            "city": "FAIRFAX",
            "state": "OK",
            "postal_code": "746373023",
            "telephone_number": "918-642-3100",
            "fax_number": "918-642-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E GRAND AVE",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746015205",
            "telephone_number": "580-302-8270",
            "fax_number": "580-749-5682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 N Main St",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "OK",
            "postal_code": "746373023",
            "country_code": "US",
            "telephone_number": "918-642-3100 x226",
            "fax_number": "918-642-5639",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "716 S Highway 77",
            "address_purpose": "LOCATION",
            "city": "Newkirk",
            "state": "OK",
            "postal_code": "746477009",
            "country_code": "US",
            "telephone_number": "580-362-2555",
            "fax_number": "580-362-2948",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "119 W Main St",
            "address_purpose": "LOCATION",
            "city": "Hominy",
            "state": "OK",
            "postal_code": "740351031",
            "country_code": "US",
            "telephone_number": "918-885-4640",
            "fax_number": "918-885-4644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "KRISTIN",
        "middle_name": "M.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-05",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "3832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200446140A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "287620YRHZ",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bridgeway
• Bridgeway, Inc.
• Noelle Brien
• Michael Thomas Bristow, MS,CCC-SLP
• Shannon Dee Broadie
• Brown & Brown, D.D.S.
• Beverly F. Brown, L.P.N.
• Carol Ann Brown
• Cherish Brown
• Dawn Brown, APRN,FNP-C

• All providers in Ponca City, OK
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; 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.