MRS. TAMARA KAYE BROCKMAN (PNP) – Pediatric Nurse Practitioner, NPI 1639224140
Pediatric Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. TAMARA KAYE BROCKMAN (PNP)
1 CHILDRENS PLZ # 10
CHILDREN MEDICAL CENTER DEPT OF NEPHROLOGY
DAYTON, OH 454041898
Phone: (937) 641-3304
Fax: (937) 641-6400
Type: Location
1321, Terrington Way, Miamisburg, Montgomery County, Ohio, 45342, United States
MIAMISBURG, OH 453424280
Phone: (937) 247-5372
Fax: (937) 641-4600
Type: Mailing
9000 N Main St Ste 332
Englewood, OH 454151185
Phone: (937) 832-7337
Type: Location
1 Childrens Plz
Dayton, OH 454041873
Phone: (937) 641-4000
Fax: (937) 641-4500
Type: Location
1425 N Fairfield Rd Ste 130
Beavercreek, OH 454322674
Phone: (937) 320-1950
Type: Location
1711 Germantown Pike
Dayton, OH 45417
Phone: (937) 641-3142
Fax: (937) 641-4172
Type: Location
6044 Wilmington Pike
Dayton, OH 454597006
Phone: (937) 641-3270
Fax: (937) 641-6108
Type: Location
3333 W Tech Rd
Miamisburg, OH 453420955
Phone: (937) 641-3400
Fax: (937) 641-4880
Type: Location
7787 Cox Ln
West Chester, OH 450696549
Phone: (937) 641-5757
Fax: (513) 847-1192
Type: Location
5501 Far Hills Ave Ste 200
Dayton, OH 454292203
Phone: (937) 436-2866
Fax: (937) 436-1468
Type: Location
8501 Old Troy Pike
Huber Heights, OH 454241054
Phone: (937) 641-4360
Fax: (937) 641-3791
Type: Location
3301 Dayton Xenia Rd Ste 200
Beavercreek, OH 454322759
Phone: (937) 641-5098
Fax: (937) 912-9395
Type: Location
860 Valley St.
Dayton, OH 45404
Phone: (937) 641-3060
Fax: (937) 641-3285
Type: Location
1 CHILDRENS PLZ
DAYTON, OH 454041815
Phone: (937) 641-3000
Type: Mailing
662 N MAIN ST
SPRINGBORO, OH 450669553
Phone: (937) 641-5066
Fax: (937) 550-9797
Type: Location
PO BOX 933432
CLEVELAND, OH 441930039
Phone: (937) 641-3000
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2016-09-08
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 |
|---|---|---|---|---|
| I20160908001508 | I | Nurse Practitioner | OH | 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 45404)
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