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BROOKLYN RAE FORT NP-C
NPI 1114655214
Nurse Practitioner in Springfield, MO

Active since August 08, 2022PECOS EnrolledAccepts Medicare Assignment
3850 S NATIONAL AVE STE 705, SPRINGFIELD, MO 65807(417) 900-3407(417) 889-0476 Get Directions Write a Review

NPPES record last updated: February 26, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 24, 2024, Aug 8, 2022 (2 updates tracked since 2022).

About Brooklyn Rae Fort Np-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROOKLYN RAE FORT NP-C (NPI 1114655214) is an individual nurse practitioner in Springfield, Missouri, licensed in Missouri (2024009420) and active in the NPI registry since August 2022. She is enrolled in Medicare PECOS, maintains 6 additional practice locations, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1114655214
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameBROOKLYN RAE FORTCredential: NP-C
Location Address3850 S NATIONAL AVE STE 705Springfield, MO 65807-5239
Mailing Address801 York StManitowoc, WI 54220-4630 · (920) 663-9008 · Fax (920) 684-1439
Phone(417) 900-3407
Fax(417) 889-0476
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateAugust 8, 2022
Last NPPES UpdateFebruary 26, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 26, 2026
✔ NPI 1114655214 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in MO · 2024009420
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
3850 S NATIONAL AVE STE 705, Springfield, MO 65807
Open in Google Maps ↗

Secondary Practice Locations 6

Location 1590 BIRCH RD STE 2CHOLLISTER, MO 65672-9607 · Phone (417) 815-6737 · Fax (417) 690-3862
Location 22200 E CLEVELAND STMONETT, MO 65708-6149 · Phone (417) 900-3407 · Fax (417) 889-0476
Location 3109 PINEHURST DRBRANSON, MO 65616-2796 · Phone (417) 888-0858 · Fax (417) 889-0476
Location 4331 HOSPITAL DR STE CLEBANON, MO 65536-9251 · Phone (417) 334-7200 · Fax (417) 334-7299
Location 51240 E INDEPENDENCE ST STE 100SPRINGFIELD, MO 65804-4201 · Phone (417) 900-3407 · Fax (417) 889-0476
Location 61240 E INDEPENDENCE ST STE 200SPRINGFIELD, MO 65804-4201 · Phone (417) 900-3407 · Fax (417) 889-0476

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Cox HealthPlans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Brooklyn Rae Fort Np-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID648719757
PECOS Enrollment IDI20240903001728
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Brooklyn Fort reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Forefront Dermatology, S.C.
Same address
Dermatology
3850 S NATIONAL AVE STE 705
Springfield, MO 65807
  • Reassigned Medicare billing, Missouri enrollment
  • Medicare enrollment name: Forefront Dermatology Sc
  • 28 clinicians in this Medicare group
NPI 1306703533 (417) 900-3407
Mike Swann, MD, LLC
Same address
Procedural Dermatology
3850 S NATIONAL AVE, SUITE 705
Springfield, MO 65807
  • Reassigned Medicare billing, Missouri enrollment
  • 7 clinicians in this Medicare group
NPI 1689907081 (417) 888-0858

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 65807 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.64 typical visit price
range $52.28 – $161.24
Typical copayment $20.41 (range $13.07 – $40.31)
Most-billed visit code 99203
Established Patient
$93.24 typical visit price
range $16.30 – $131.05
Typical copayment $23.31 (range $4.07 – $32.76)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. AUTUMN LYNN BERTHOLDI PA-C
Physician Assistant
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 900-3407
MICHAEL KREMER
Dermatology
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 888-0858
FOREFRONT DERMATOLOGY, S.C.
Dermatology
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 900-3407
CRAIG NAUGLE, MD LLC
Dermatology
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 889-3332
LORI RENEE MILLER NP-C
Nurse Practitioner
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 900-3407
HANNAH ANOUSH LEE NP-C
Nurse Practitioner
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 900-3407
BRETT NEILL MD
Dermatology (MOHS-Micrographic Surgery)
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 888-0858
FOREFRONT DERMATOLOGY - MISSOURI, LLC
Dermatology
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 65807
Greene County (417) 900-3407

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brooklyn Fort's NPI number?

The NPI number for Brooklyn Fort is 1114655214. It was assigned to this individual provider in the NPPES registry on August 8, 2022.

Where is Brooklyn Fort located?

Brooklyn Fort practices at 3850 S National Ave Ste 705, Springfield, MO 65807. The listed phone number is (417) 900-3407.

What is Brooklyn Fort's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Brooklyn Fort enrolled in Medicare?

Yes. Brooklyn Fort is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Brooklyn Fort's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Brooklyn Fort reassigns Medicare benefits to 2 organizations: Forefront Dermatology, S.C. (Springfield, MO) and Mike Swann, MD, LLC (Springfield, MO). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Brooklyn Fort's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Brooklyn Fort accept?

Health plans from Anthem Blue Cross and Blue Shield and Cox HealthPlans list Brooklyn Fort as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brooklyn Fort was last updated on February 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.