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

Q: 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.

Q: What is Brooklyn Fort's specialty?

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

Q: 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 5 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.

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: August 16, 2026.

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

On this page

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 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

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Cox HealthPlans, Medica.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

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