NPIMap

Individual provider Active NPI

Brock Perly, PA-C

  • Physician Assistant
  • Altamonte Springs, FL
National Provider Identifier
1083383699
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9114893 Issued in FL
Practice address
661 E Altamonte Dr Ste 325
Altamonte Springs, FL 32701-5103
Phone
(407) 303-4120
Fax
(407) 303-4124
NPI assigned
Sep 8, 2021
Last updated
Oct 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA9114893 FL Primary

Addresses

Primary practice location

661 E Altamonte Dr Ste 325
Altamonte Springs, FL 32701-5103

Mailing address

661 E Altamonte Dr Ste 325
Altamonte Springs, FL 32701-5103
Phone (407) 303-4120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211118003242 FL Practitioner - Physician Assistant 5294124806 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2501 N Orange Ave
Orlando, FL 32804-4641

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-2570

631 E Altamonte Dr
Suite 231
Altamonte Springs, FL 32701-4802
Phone (407) 303-5214

661 E Altamonte Dr
Altamonte Springs, FL 32701-5103
Phone (407) 303-5204

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Oct 10, 2022 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Oct 10, 2022 Accepting new patients

Locations

661 E Altamonte Dr
Ste 325
Altamonte Springs, FL 32701
Phone (407) 303-4120

400 Celebration Pl
Ste A120
Kissimmee, FL 34747
Phone (407) 228-8066

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

133 Benmore Dr
Ste 100
Winter Park, FL 32792

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: bperly250942@adventhealth.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1083383699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 E ALTAMONTE DR STE 325",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327015103",
            "telephone_number": "407-303-4120",
            "fax_number": "407-303-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 E ALTAMONTE DR STE 325",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327015103",
            "telephone_number": "407-303-4120",
            "fax_number": "407-303-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERLY",
        "first_name": "BROCK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-08",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9114893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Altamonte Springs, FL

Sources for this page

Verify at the official NPI Registry.