Kevin Patrick Bryan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME121818 Issued in FL

Practice address

4200 Sun N Lake Blvd
Sebring, FL 33872-1986

Phone

(407) 975-0412

Fax

(407) 975-0407

NPI assigned

Sep 13, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180

  FL

  Medicare reassignment NPD
• Florida Hospital Medical Group Inc

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  FL, Pediatrics

  Medicare reassignment NPD
• Hospital Medicine Services of FL, LLC

  • Hospitalist Physician
  • Aventura, FL
  • NPI 1710684857

  FL, Hospitalist

  Medicare reassignment NPD
• Hospital Physician Services of Florida PA

  • Hospitalist Physician
  • Pensacola, FL
  • NPI 1558718635

  FL, Hospitalist

  Medicare reassignment NPD
• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650

  FL, Pediatrics

  Medicare reassignment NPD
• Florida Hospital Medical Group Inc

  • Prosthetic/Orthotic Supplier
  • Minneola, FL
  • NPI 1285591545
  NPD
• Blue Job Emergency Physicians LLC

  • Emergency Medicine Physician
  • Fort Walton Beach, FL
  • NPI 1457760142
  NPD (past)

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1104811512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 SUN N LAKE BLVD",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338721986",
            "telephone_number": "407-975-0412",
            "fax_number": "407-975-0407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 SUN N LAKE BLVD",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338721986",
            "telephone_number": "407-975-0412",
            "fax_number": "407-975-0407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 Sun N Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Sebring",
            "state": "FL",
            "postal_code": "338721986",
            "country_code": "US",
            "telephone_number": "407-975-0412",
            "fax_number": "407-975-0407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "307 Boatner Rd",
            "address_2": "Suite 114",
            "address_purpose": "LOCATION",
            "city": "Eglin AFB",
            "state": "FL",
            "postal_code": "325421391",
            "country_code": "US",
            "telephone_number": "850-883-8550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "KEVIN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD417302",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "ME121818",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME121818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015608500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Toni Brooks, RN
• Barry Matthew Brown, CNMT
• Lakiera Brown, LPN
• Rachell Denice Brown
• Bruce Borkosky PSYD PA
• Bucci Eyecare, PLLC
• Jessie Leigh Buchanan, APRN
• Sabrina Buckholdt, LPN
• Annette M. Bullard, COTA
• Deborah Rhoda Caballero Rodriguez

• All providers in Sebring, FL
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.