BROOKLYN RAE FORT (NP-C) – Registered Nurse, NPI 1114655214
Registered Nurse
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7,017 NURSE PRACTITIONER in MO
Provider Addresses for BROOKLYN RAE FORT (NP-C)
331 HOSPITAL DR STE C
LEBANON, MO 655369251
Phone: (417) 334-7200
Fax: (417) 334-7299
Type: Location
1240 E INDEPENDENCE ST STE 100
SPRINGFIELD, MO 658044201
Phone: (417) 900-3407
Fax: (417) 889-0476
Type: Location
2200 E CLEVELAND ST
MONETT, MO 657086149
Phone: (417) 900-3407
Fax: (417) 889-0476
Type: Location
590 BIRCH RD STE 2C
HOLLISTER, MO 656729607
Phone: (417) 815-6737
Fax: (417) 690-3862
Type: Location
1240 E INDEPENDENCE ST STE 200
SPRINGFIELD, MO 658044201
Phone: (417) 900-3407
Fax: (417) 889-0476
Type: Location
109 PINEHURST DR
BRANSON, MO 656162796
Phone: (417) 888-0858
Fax: (417) 889-0476
Type: Location
2310 PERSHING DR
HAYS, KS 676013032
Phone: (785) 269-7958
Type: Mailing
600 PARK ST
HAYS, KS 676014099
Phone: (785) 628-3478
Type: Location
801 YORK ST
MANITOWOC, WI 542204630
Phone: (920) 663-9008
Fax: (920) 684-1439
Type: Mailing
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 658075239
Phone: (417) 900-3407
Fax: (417) 889-0476
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 35 Open Payments records for all available years, with a total value of $640.
Total Amount is formed as General ($640) + Research ($0) + Ownership ($0) = $640.
Last reported payment date: 2024-12-31 • Largest payer in this snapshot: ABBVIE INC. ($210).
Total Amount
$640
General + Research + Ownership
Payments
35
Total payment records
General Amount
$640
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-31
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $210 |
| Janssen Biotech, Inc. | $88 |
| UCB, Inc. | $69 |
| Lilly USA, LLC | $65 |
| E.R. Squibb & Sons, L.L.C. | $57 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-09-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240903001728 | I | Nurse Practitioner | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 65536)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| Physician Assistant | VA | |
| - | VA | |
| D E R M A T O L O G Y | TX | |
| - | WI | |
| D E R M A T O L O G Y | AL | |
| D E R M A T O L O G Y | WI | |
| - | WI | |
| Physician Assistant | NY | |
| D E R M A T O L O G Y | WA |
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