Ricky Brockington
Individual provider Active NPI Nurse Practitioner · Franklin, VA
NPI 1871108233 · NPPES record last updated Aug 12, 2021
Key facts
- NPI
- 1871108233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 0024180104 (VA)
- Practice address
- 102 Fairview Dr Ste B
Franklin, VA 23851-1206 - Phone
- (757) 562-2158
- Fax
- (757) 516-8019
- NPI assigned
- Sep 12, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Bon Secours Medical Group Hampton Roads Primary Care LLC
Powerback Rehabilitation LLC
Practice addresses (Care Compare)
102 Fairview Dr
Franklin, VA 23851-1206
1401 N High St
Franklin, VA 23851-1244
Phone (757) 516-8130
3537 Airline Blvd
Suite 1
Portsmouth, VA 23701-2650
Phone (757) 738-1225
Hospital & facility affiliations
- Southampton Memorial Home Health
- Sentara Home Care Services-Suffolk
- Bon Secours Southampton Memorial Hospital
- Sentara Obici Hospital
- Bon Secours Southside Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210401000757 | VA | Practitioner - Nurse Practitioner | 7810304235 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bon Secours Medical Group Hampton Roads Primary Care LLC | Current |
Accepting new patients |
Locations
22708 Main St
Courtland, VA 23837
Phone (757) 653-2007
102 Fairview Dr
Ste B
Franklin, VA 23851
Phone (757) 562-2158
3537 Airline Blvd
Ste 1
Portsmouth, VA 23701
Phone (757) 738-1225
Interoperability endpoints
- rbrockington1149733@direct.bsmhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 0024180104 | VA | Yes |
Addresses
Primary practice location
102 Fairview Dr Ste B
Franklin, VA 23851-1206
Mailing address
19124 Lakeside Dr
Courtland, VA 23837-2634
Phone (757) 562-2004
Other practice location 1
19124 Lakeside Dr
Courtland, VA 23837-2634
Phone (757) 562-2004
Other providers in Franklin, VA
- Orga Marie Boone
- Donald Bruce Bowling
- Susan Boyle
- Sherrill N Brandon
- Breath of Air Homecare LLC
- Justin Broughton
- Sydney Caroline Browder
- Nicole Brown
- Regina J Brown
- Anne Larmore Bruehl
All providers in Franklin, VA · Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.