Brooke Nicole Macdougall, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A154405 Issued in IA

Practice address

1800 E 54TH St Ste B
Davenport, IA 52807-2852

Phone

(563) 344-7546

Fax

(563) 344-1373

NPI assigned

May 8, 2019

Last updated

May 8, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA, IL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bmacdougall@directaddress.net

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.

• Soderstrom Dermatology Center S C

  • Dermatology Physician
  • Peoria, IL
  • NPI 1710931670

  IA

  Medicare reassignment NPD
• Soderstrom Dermatology Center S C

  dba Peoria Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Peoria, IL
  • NPI 1053362343
  NPD

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1801451554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144689",
            "telephone_number": "309-674-7546",
            "fax_number": "309-282-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E 54TH ST STE B",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072852",
            "telephone_number": "563-344-7546",
            "fax_number": "563-344-1373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2315 Roosevelt St",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "IA",
            "postal_code": "527322412",
            "country_code": "US",
            "telephone_number": "563-242-3571",
            "fax_number": "563-243-4971",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2300A Park Ave",
            "address_purpose": "LOCATION",
            "city": "Muscatine",
            "state": "IA",
            "postal_code": "527615444",
            "country_code": "US",
            "telephone_number": "563-263-2113",
            "fax_number": "563-263-2619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACDOUGALL",
        "first_name": "BROOKE",
        "middle_name": "NICOLE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A154405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica of America Inc. (Target Optical #1885)
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• Lauren Elizabeth Lybbert, DC
• Alexandria Nicole Lyon, PA
• Thomas E Lyons, MD
• Marguerite A Macek, ARNP
• Joseph S Maciejko, PH.D.
• Madison County Medical Equipment, Inc. (AeroCare)
• Akshay Kantilal Mahadevia, MD
• Geeta Mahadevia, M.D.

• Family Nurse Practitioner in Davenport, IA
• Providers in Davenport, IA by specialty
• Family Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.