CMS-1500 Box 24J / 33a • NPI
1790039196
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LA2200X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health
Box 32 Service Location & ZIP+4
140 FOX RD, VAN WERT, OH, 45891-2475
✓ 9-Digit EDI 837 ZIP+4 (45891-2475)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1790039196 (KELSEY RENEE BROKAMP, ANP-BC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1790039196)
Medicare Beneficiaries
356
Total Billed Services
589
Distinct CPT/HCPCS Codes
15
Medicare Allowed Total
$58,277.47
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
76981 | Ultrasound scan of organ tissue for measuring elasticity | 30 |
99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | 106 |
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 104 |
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 225 |
99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 24 |
99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 12 |
99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 60 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Alosetron Hcl Alosetron Hcl | 11 | <11 |
| Budesonide Dr Budesonide | 11 | <11 |
| Colestipol Hcl Colestipol Hcl | 34 | 17 |
| Dicyclomine Hcl Dicyclomine Hcl | 42 | 13 |
| Diphenoxylate-Atropine Diphenoxylate Hcl/Atropine | 25 | <11 |
| Esomeprazole Magnesium Esomeprazole Magnesium | 23 | <11 |
| Famotidine Famotidine | 63 | 24 |
| Furosemide Furosemide | 17 | <11 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1790039196 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | KELSEY RENEE BROKAMP, ANP-BC |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health NUCC Code: 363LA2200X (Nurse Practitioner, Adult Health) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 140 FOX RD, VAN WERT, OH, 45891-2475 |
| Practice Telephone / Fax | Tel: (419) 238-7727 | Fax: (419) 238-7768 |
| Administrative Mailing Address | 21051 ROAD T, FORT JENNINGS, OH, 45844-9307 |
| Enumeration & Last Sync | Enumerated: 2012-11-07 | CMS Record Updated: 2024-04-18 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LA2200X)
What Does Taxonomy Code 363LA2200X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LA2200X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (KELSEY RENEE BROKAMP, ANP-BC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363LA2200X — Nurse Practitioner, Adult HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health | State: OH | License: NP13989 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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