Jessica Brooks

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

1992372403 Issued in CT

Practice address

140 Spaugy Hollow Rd
Connellsville, PA 15425-6518

Phone

(724) 963-7083

NPI assigned

Aug 3, 2017

Last updated

Oct 3, 2024By 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 4

Addresses

Other names 1

• Jessica Shipley Former name

Medicare fee-for-service enrollment

Enrolled in PA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jessica.brooks.1@25522.direct.athenahealth.com

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.

• Centerville Clinics, Inc.

  • Family Medicine Physician
  • Fredericktown, PA
  • NPI 1801877048
  Medicare reassignment NPD
• Centerville Clinics, Inc

  • Specialist
  • Fredericktown, PA
  • NPI 1720339393
  NPD
• Centerville Clinics, Inc.

  • Radiologic Technologist
  • Fredericktown, PA
  • NPI 1568566867
  NPD
• Centerville Clinics, Inc.

  • Clinical Medical Laboratory
  • Fredericktown, PA
  • NPI 1811978166
  NPD
• Centerville Clinics, Inc.

  • Cardiovascular Disease Physician
  • Fredericktown, PA
  • NPI 1902887250
  NPD
• Centerville Clinics, Inc.

  • Podiatrist
  • Fredericktown, PA
  • NPI 1922089275
  NPD
• Sia Medical PC

  dba Flyte Medical PC

  • Obesity Medicine (Preventive Medicine) Physician
  • New York, NY
  • NPI 1043889967
  NPD (past)

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

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1952825663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SPAUGY HOLLOW RD",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154256518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SPAUGY HOLLOW RD",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154256518",
            "telephone_number": "724-963-7083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "148 E 38th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100162607",
            "country_code": "US",
            "telephone_number": "833-955-3592",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 W Main St Ste 16",
            "address_purpose": "LOCATION",
            "city": "Wyckoff",
            "state": "NJ",
            "postal_code": "074811406",
            "country_code": "US",
            "telephone_number": "833-955-3592",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "69 Grove St",
            "address_purpose": "LOCATION",
            "city": "New Canaan",
            "state": "CT",
            "postal_code": "068405325",
            "country_code": "US",
            "telephone_number": "724-963-7083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-03",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CT",
            "license": "1992372403",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NY",
            "license": "1043889967",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NJ",
            "license": "1992372403",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "F06171944",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SHIPLEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Krista Boyer
• Bradley Anesthesiology PC
• William L Bradley, MD
• Angelia Elizabeth Brancheck, M. ED, LBS
• Ben Paul Brinkley, M.D.
• Haley Morgan Brothers
• Ashley Dawn Brown, LCSW
• Ryan Brown
• Bruner Chiropractic Health Center, Inc
• Michael Todd Bruner, D.C.

• Medical Specialty Clinic/Center in Connellsville, PA
• Providers in Connellsville, PA by specialty
• Medical Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.