NPIMap

Organization Active NPI

Loggerhead Medical LLC

  • Pain Medicine (Anesthesiology) Physician
  • Melbourne, FL
National Provider Identifier
1023041001
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
ME51048 Issued in FL
Legal business name
LOGGERHEAD MEDICAL LLC
Practice address
307 E New Haven Ave
Melbourne, FL 32901-4576
Phone
(321) 729-8223
Fax
(321) 729-6252
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

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

Authorized official

Name
Nancy L Layton, M.D.
Title
Owner
Phone
(321) 729-8223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X ME51048 FL Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X ME105112 FL

Addresses

Primary practice location

307 E New Haven Ave
Melbourne, FL 32901-4576

Mailing address

PO Box 3123
St Augustine, FL 32085-3123
Phone (904) 824-4990

Other identifiers 4

IdentifierTypeStateIssuer
275274302MedicaidFL
39339OtherFLBCBS
275274301MedicaidFL
DC0738OtherFLMEDICARE RAILROAD

Other names 1

  • Advanced Pain and Neuromuscular Consultants of Brevard Doing business as

National Provider Directory

National Provider Directory

Locations

8075 Spyglass Hill Rd
Ste 105
Melbourne, FL 32940
Phone (321) 259-8993

630 S Wickham Rd
Ste 1
West Melbourne, FL 32904
Phone (321) 729-8223

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1023041001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3123",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320853123",
            "telephone_number": "904-824-4990",
            "fax_number": "904-824-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E NEW HAVEN AVE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329014576",
            "telephone_number": "321-729-8223",
            "fax_number": "321-729-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGGERHEAD MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "LAYTON",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-729-8223",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME51048",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "FL",
            "license": "ME105112",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275274302",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "39339",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275274301",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DC0738",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Pain and Neuromuscular Consultants of Brevard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 15, 2011; 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.