Brevard Health Alliance Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Cocoa, FL
NPI 1104549484 · NPPES record last updated Dec 19, 2022
Key facts
- NPI
- 1104549484
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BREVARD HEALTH ALLIANCE INC
- Practice address
- 905 Pineda St
Cocoa, FL 32922-6370 - Phone
- (321) 241-6800
- Fax
- (321) 241-6888
- NPI assigned
- Sep 22, 2022
- Organization subpart
- No
Authorized official
- Name
- Angela Craig
- Title
- Director of Billing
- Phone
- (321) 698-3446
Other NPIs with the same Medicare PAC ID 17
Corporate family (same tax ID) 41
Practitioners 51
-
Sara Jane Ball, PA-C
-
Alexandra Ruby Bennett, PA-C
-
Sean Paul Claeys, D.O.
-
Kinard Cooper, APRN
-
Migling Cuervo, APRN
-
Alisha Dotson, PA-C
-
Katie Fillion, M.D.
-
Jessica Ann Garcia, APRN
-
Naomi Ruth Grammer, RCSWI
-
Michael D. Griffin, APRN
-
Jeffrey Andrew Gulick, D.O.
-
Wayne H Harris, D.O.
-
Maryann Raafat Henin, D.O.
-
Sara Janette Hewitt, LCSW
-
Colin Frank Kennedy, PA-C
-
Flavia Marques Campoy, FNP-C
-
Sajida Mathew, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Federally qualified health center certification: CCN 101812
- Legal name
- BREVARD HEALTH ALLIANCE INC
- Doing business as
- BREVARD HEALTH ALLIANCE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 20, 2022
- Last certification
- Dec 20, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Apr 1, 2003 in FL
- Enrollment address
- 905 Pineda St
Cocoa, FL 32922-6370
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Santiago |
Corporate Director |
Aug 1, 2019 | |
| Lena Marie Knapp |
Corporate Director |
Nov 1, 2018 | |
| Brett Esrock |
Corporate Director |
Aug 1, 2020 | |
| Carice Cunningham |
Corporate Director |
Oct 1, 2020 | |
| Colleen Browne |
Corporate Director |
Mar 1, 2020 | |
| Erin Shea |
Corporate Director |
Nov 1, 2018 | |
| Kevin Hill |
Corporate Director |
Dec 1, 2020 | |
| Richard a Helton |
Corporate Officer |
Jun 1, 2016 | |
| Corporate Director |
Jun 1, 2016 | ||
| W-2 Managing Employee |
Jun 1, 2016 | ||
| Doreen Nimblett |
Corporate Director |
Dec 1, 2020 | |
| Keith Donald |
Corporate Director |
Oct 1, 2018 | |
| Mike Young |
Corporate Director |
Oct 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221217000481 | FL | Part a Provider - Federally Qualified Health Center (FQHC) | 0446201768 | Practice locations: Cocoa, FL |
National Provider Directory
- Tax ID family
- The Brevard Health Alliance Inc
Locations
17 Silver Palm Ave
Melbourne, FL 32901
Phone (321) 725-9041
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
905 Pineda St
Cocoa, FL 32922-6370
Mailing address
PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 698-3446
Other names
- Brevard Health Alliance
Other providers in Cocoa, FL
- Quanita Latrice Bowden
- Ashley Bowers
- J'Hane Bradbury
- Tara R Breen
- Brevard Health Alliance
- Brevard Health Alliance Inc
- Brevard Health Alliance Inc
- Brevard Health Alliance Inc
- Brevard Health Alliance Inc
- Brevard Independent Supportive Services LLC
All providers in Cocoa, FL · Federally Qualified Health Center (FQHC) in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.