NPIMap

Organization Active NPI

Cancer Care Centers of Brevard Inc

  • Hematology & Oncology Physician
  • Palm Bay, FL
National Provider Identifier
1114590429
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
CANCER CARE CENTERS OF BREVARD INC
Practice address
20 San Filippo Dr SE
Palm Bay, FL 32909-2200
Phone
(321) 725-8300
Fax
(321) 725-1555
NPI assigned
Jul 23, 2021
Last updated
Jul 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Authorized official

Name
Gail Knight Erentreich
Title
Director of Clinical Operations
Phone
(321) 636-2111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X NU Primary

Addresses

Primary practice location

20 San Filippo Dr SE
Palm Bay, FL 32909-2200

Mailing address

1430 Pine St
Melbourne, FL 32901-3119
Phone (321) 674-5050

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2044227Cancer Care Centers of Brevard20 San Filippo Dr SE, Palm Bay, FL 32909AccreditationJan 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cancer Care Centers of Brevard Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

20 San Filippo Dr SE
Palm Bay, FL 32909
Phone (321) 725-8300

NPI Registry JSON

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1114590429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 PINE ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013119",
            "telephone_number": "321-674-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 SAN FILIPPO DR SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329092200",
            "telephone_number": "321-725-8300",
            "fax_number": "321-725-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANCER CARE CENTERS OF BREVARD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A",
        "authorized_official_last_name": "ERENTREICH",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "KNIGHT",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "321-636-2111"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.