NPIMap

Individual provider Active NPI

Kelsey Renee Brokamp, ANP-BC

  • Adult Health Nurse Practitioner
  • Van Wert, OH
National Provider Identifier
1790039196
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
NP13989 Issued in OH
Practice address
140 Fox Rd
Van Wert, OH 45891-2475
Phone
(419) 238-7727
Fax
(419) 238-7768
NPI assigned
Nov 7, 2012
Last updated
Apr 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NP13989 OH Primary

Addresses

Primary practice location

140 Fox Rd
Van Wert, OH 45891-2475

Mailing address

21051 Road T
Fort Jennings, OH 45844-9307

Other identifiers 1

IdentifierTypeStateIssuer
0080308MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelsey.brokamp@gastrohealth.eclinicaldirectplus.com GCGA Physicians Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130214000088 OH Practitioner - Nurse Practitioner 8628222973 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Ohio State University College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gcga Physicians Inc.Group PAC ID 4284618224, 76 clinicians

Practice addresses (Care Compare)

2793 Shawnee Rd
Lima, OH 45806-1444
Phone (419) 227-8209

2925 Vernon PL
Cincinnati, OH 45219-2425

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP13989OHMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gcga Physicians Inc. CurrentSince Sep 3, 2021 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Galloway Anesthesia Associates LLC Past Accepting new patients

Locations

139 Garau St
Bluffton, OH 45817
Phone (419) 358-9010

2925 Vernon Pl
Ste 100
Cincinnati, OH 45219
Phone (513) 872-4555

2793 Shawnee Rd
Lima, OH 45806
Phone (419) 204-1501

Organizations & group practices 3

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 6

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": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1790039196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21051 ROAD T",
            "city": "FORT JENNINGS",
            "state": "OH",
            "postal_code": "458449307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 FOX RD",
            "city": "VAN WERT",
            "state": "OH",
            "postal_code": "458912475",
            "telephone_number": "419-238-7727",
            "fax_number": "419-238-7768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKAMP",
        "first_name": "KELSEY",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-07",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "NP13989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0080308",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelsey.brokamp@gastrohealth.eclinicaldirectplus.com",
            "affiliation": "Y",
            "endpointDescription": "eCW Direct messaging Address",
            "affiliationName": "GCGA Physicians Inc.",
            "address_1": "2925 Vernon Pl",
            "address_2": "Suite 100",
            "city": "Cincinnati",
            "state": "OH",
            "country_code": "US",
            "postal_code": "452192425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Van Wert, OH

Sources for this page

Verify at the official NPI Registry.