Brandon Bogard, APRN
Individual provider Active NPI Nurse Practitioner · Titusville, FL
NPI 1114665148 · NPPES record last updated Sep 21, 2023
Key facts
- NPI
- 1114665148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APRN11016143 (FL)
- Practice address
- 1840 S Washington Ave
Titusville, FL 32780-4716 - Phone
- (321) 360-5577
- Fax
- (321) 806-2087
- NPI assigned
- May 20, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Brevard Physician Associates PLLC
Practice addresses (Care Compare)
1350 Hickory St
Melbourne, FL 32901-3224
Phone (321) 434-7000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220628001655 | FL | Practitioner - Nurse Practitioner | 9830578483 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN11016143 | FL | MD | Nurse Practitioner |
Practice roles (3 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medfast Urgent Care Centers LLC | Current |
Accepting new patients | |
| Brevard Physician Associates, PLLC | Nurse Practitioner | Current |
Accepting new patients |
| Medfast Urgent Care Centers, LLC | Current |
Accepting new patients |
Locations
701 W Cocoa Beach Cswy
Cocoa Beach, FL 32931
Phone (321) 799-7111
1350 Hickory St
Melbourne, FL 32901
Phone (321) 434-1771
5005 Port St John Pkwy
Port St John, FL 32927
Phone (321) 504-0556
1840 S Washington Ave
Titusville, FL 32780
Phone (321) 360-5577
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN11016143 | FL | Yes |
Addresses
Primary practice location
1840 S Washington Ave
Titusville, FL 32780-4716
Mailing address
3300 S Fiske Blvd
Rockledge, FL 32955-4306
Phone (321) 868-7272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PG869 | Other | FL | MEDICARE HF |
| 114654100 | Medicaid | FL |
Other providers in Titusville, FL
- BNS Medical, LLC
- Sherry Lynn Boaz
- Betty Bobay
- Summer Renee Bodziak
- Jennifer Boffil
- Tara Bonck
- Victor R Boodhoo
- Laurie Lucinda Borah
- Cara Bortz
- Ehab Boulos
All providers in Titusville, FL · Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2023. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.