NPIMap

Organization Active NPI

Pediatrics in Brevard, P.a.

  • Pediatrics Physician
  • Melbourne, FL
National Provider Identifier
1003807637
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRICS IN BREVARD, P.A.
Practice address
8057 Spyglass Hill Rd Ste 102
Melbourne, FL 32940-8565
Phone
(321) 435-9800
Fax
(321) 435-9803
NPI assigned
Nov 2, 2005
Last updated
Oct 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Melissa Loiselle
Title
Credentialing Coordinator
Phone
(321) 435-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

8057 Spyglass Hill Rd Ste 102
Melbourne, FL 32940-8565

Mailing address

134 S Woods Dr
Rockledge, FL 32955-3262

Other identifiers 1

IdentifierTypeStateIssuer
253255703MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Pediatrics in Brevard PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

7332 Office Park Pl
Melbourne, FL 32940

8057 Spyglass Hill Rd
Ste 102
Viera, FL 32940
Phone (321) 428-4545

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1003807637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 S WOODS DR",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329553262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8057 SPYGLASS HILL RD STE 102",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408565",
            "telephone_number": "321-435-9800",
            "fax_number": "321-435-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS IN BREVARD, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "LOISELLE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "321-435-9800"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253255703",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; 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.