Brooklyn Rae Fort, NP is a medicare enrolled "Dermatology" in Springfield, Missouri. Her current practice location is
3850 S National Ave Ste 705, Springfield, Missouri. You can reach out to her office (for appointments etc.) via phone at
(417) 888-0858.
Brooklyn Rae Fort is licensed to practice in Missouri (license number 2024009420) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1114655214.
Provider's Profile
| Full Name | Brooklyn Rae Fort |
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| Gender | Female |
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| Speciality | Dermatology |
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| Location | 3850 S National Ave Ste 705, Springfield, Missouri |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1114655214
- Provider Enumeration Date: 08/08/2022
- Last Update Date: 01/17/2025
Medicare PECOS Information:
- PECOS PAC ID: 0648719757
- Enrollment ID: I20240903001728
Medical Identifiers
Medical identifiers for Brooklyn Rae Fort such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1114655214 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | 2024009420 (Missouri) | Secondary |
| 207N00000X | Dermatology | 2024009420 (Missouri) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Brooklyn Rae Fort allows following entities to bill medicare on her behalf.
| Entity Name | Mike Swann, Md, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1689907081
PECOS PAC ID: 0941346068
Enrollment ID: O20091002000604 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Brooklyn Rae Fort is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Brooklyn Rae Fort, NP
3850 S National Ave Ste 705,
Springfield, MO 65807-5239
Ph: (417) 888-0858 | Brooklyn Rae Fort, NP
3850 S National Ave Ste 705,
Springfield, MO 65807-5239
Ph: (417) 888-0858 |
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