NPIMap

Organization Active NPI

North Brevard Medical Support, Inc

  • Diagnostic Radiology Physician
  • Titusville, FL
National Provider Identifier
1073287702
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
NORTH BREVARD MEDICAL SUPPORT, INC
Practice address
250 Harrison St Ste 100
Titusville, FL 32780-5098
Phone
(321) 268-6674
Fax
(321) 268-6138
NPI assigned
Aug 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Authorized official

Name
Kent Andrew Bailey
Title
VP Finance
Phone
(321) 268-6111

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

250 Harrison St Ste 100
Titusville, FL 32780-5098

Mailing address

805 Century Medical Dr Ste C
Titusville, FL 32796-2100
Phone (212) 686-2643

National Provider Directory

National Provider Directory
Tax ID family
North Brevard Medical13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

250 Harrison St
Ste 100
Titusville, FL 32780
Phone (321) 268-6674

Practitioners & affiliated clinicians

Practitioners 3

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": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1073287702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 CENTURY MEDICAL DR STE C",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962100",
            "telephone_number": "212-686-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 HARRISON ST STE 100",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805098",
            "telephone_number": "321-268-6674",
            "fax_number": "321-268-6138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BREVARD MEDICAL SUPPORT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "321-268-6111"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.