Brooke Ashley Cerkovnik, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1204 Issued in WY

Practice address

1613 Stampede Ave
Cody, WY 82414-4710

Phone

(307) 587-1155

Fax

(307) 587-1166

NPI assigned

Sep 13, 2018

Last updated

Mar 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Brooke Ashley Myers Former name

Medicare fee-for-service enrollment

Enrolled in CO, WY2 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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dale R Myers MD PCGroup PAC ID 4789633819, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00104

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.

• Dale R Myers MD PC

  • Gynecology Physician
  • Cody, WY
  • NPI 1083893127
  Medicare reassignment Care Compare group
• K2 Dermatology, LLC

  • Dermatology Physician
  • Boulder, CO
  • NPI 1558094003
  Medicare reassignment
• Charles G Welch, P.C.

  • Surgery Physician
  • Cody, WY
  • NPI 1366631285
  NPD (past)
• Divine Dermatology and Surgical Institute, PLLC

  • Dermatology Physician
  • Loveland, CO
  • NPI 1104452804
  NPD (past)

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711238400000",
    "number": "1881177079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1613 STAMPEDE AVE",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824144710",
            "telephone_number": "307-587-1155",
            "fax_number": "307-587-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 STAMPEDE AVE",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824144710",
            "telephone_number": "307-587-1155",
            "fax_number": "307-587-1166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1260 Doctors Ln Ste A",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "80524",
            "country_code": "US",
            "telephone_number": "970-399-7744",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1613 Stampede Ave",
            "address_purpose": "LOCATION",
            "city": "Cody",
            "state": "WY",
            "postal_code": "824144710",
            "country_code": "US",
            "telephone_number": "307-587-1155",
            "fax_number": "307-587-1166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1715 Iron Horse Dr",
            "address_purpose": "LOCATION",
            "city": "Longmont",
            "state": "CO",
            "postal_code": "805019753",
            "country_code": "US",
            "telephone_number": "970-399-7744",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3434 47th St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803011817",
            "country_code": "US",
            "telephone_number": "303-888-8100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2900 12th Ave N",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "591017506",
            "country_code": "US",
            "telephone_number": "406-238-6820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CERKOVNIK",
        "first_name": "BROOKE",
        "middle_name": "ASHLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-13",
        "last_updated": "2024-03-24",
        "certification_date": "2024-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "69429",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006112",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "PA-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "MYERS",
            "middle_name": "ASHLEY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Crystal Dee Carter, RN, BSN
• Kathryn Lee Carter, NP
• Casper Medical Center LLC (Mountain View Regional Hospital)
• Kayla Marie Cates, LPC
• Catherine C. Schmidt, MD, PC
• Lidia Sue Cervantes
• Kay Chandler
• Charles G Welch, P.C.
• Children's Resource Center
• Chinook Chiropractic, LLC

• Physician Assistant in Cody, WY
• Providers in Cody, WY by specialty
• Physician Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2024; 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.