Brevard Orthopaedic Spine & Pain Clinic Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC

Practice address

2222 S Harbor City Blvd
Suite 530
Melbourne, FL 32901-5594

Phone

(321) 723-7716

Fax

(321) 723-0604

NPI assigned

Jun 2, 2011

Organization subpart

Yes

Parent organization

BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katrina Lopez

Title

Credentialing

Phone

(321) 541-1537

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• The BACK Center Doing business as

Tax ID family

Brevard Orthopaedic Spine4 organizations share this tax ID, including this one

Part of

Brevard Orthopaedic Spine

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Brevard Orthopaedic Spine and Pain Clinic, Inc

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Merritt Island, FL
  • NPI 1124311501
  NPD tax ID
• Brevard Orthopaedic Spine and Pain Clinic, Inc

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Port St John, FL
  • NPI 1245523620
  NPD tax ID
• Brevard Orthopaedics Spine & Pain Clinic, Inc

  • Radiologic Technologist
  • Melbourne, FL
  • NPI 1164716676
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Brevard Orthopaedic Spine & Pain Clinic Inc

  • Orthopaedic Surgery Physician
  • Melbourne, FL
  • NPI 1548237100
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1003100504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 S HARBOR CITY BLVD",
            "address_2": "SUITE 610",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015594",
            "telephone_number": "321-723-7716",
            "fax_number": "321-723-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 S HARBOR CITY BLVD",
            "address_2": "SUITE 530",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015594",
            "telephone_number": "321-723-7716",
            "fax_number": "321-723-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC",
        "enumeration_date": "2011-06-02",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "321-541-1537"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "99949",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040225700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The BACK Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The BACK Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brevard Hope Center
• Brevard Hyperbarics LLC
• Brevard Medical Dermatology, PA
• Brevard Neuro Center
• Brevard Optometry Associates
• Brevard Orthopaedic Spine & Pain Clinic Inc
• Brevard Orthopaedics Spine & Pain Clinic, Inc
• Brevard Pathology PA
• Brevard Pathology Services PA
• Brevard Physical Therapy LLC

• Physical Therapist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.