Brevard Wound Care Center, LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

BREVARD WOUND CARE CENTER, LLC

Practice address

445 Pineda CT
Melbourne, FL 32940-7555

Phone

(321) 254-1611

Fax

(321) 254-3166

NPI assigned

Jan 13, 2021

Organization subpart

No

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

Authorized official

Name

Miguel Mateos-Mora, MDNPI 1992790851

Title

Owner/Operator

Phone

(321) 254-1611

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IGIDCD

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miguel Mateos-Mora, M.D.,

  • Infectious Disease Physician
  • Melbourne, FL
  • NPI 1992790851
  Medicare reassignment NPD Authorized official
• Simone King Paul, ARNP-BC, WCC

  • Family Nurse Practitioner
  • Rockledge, FL
  • NPI 1972054864
  Medicare reassignment NPD

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1154910271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 PINEDA CT",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407555",
            "telephone_number": "321-254-1611",
            "fax_number": "321-254-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 PINEDA CT",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407555",
            "telephone_number": "321-254-1611",
            "fax_number": "321-254-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD WOUND CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "MATEOS-MORA",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "321-254-1611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Melbourne",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "445 Pineda Ct",
            "city": "Melbourne",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329407555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brevard Specialty Surgery Center LLC
• Brevard Surgery Center
• Brevard TNT Holdings
• Brevard Universal Clinical Services, LLC
• Brevard Wellness Center LLC
• Amanda Brezina
• Chad Breznay, PSYD
• Leigh A Breznay, PA-C, MPAS
• Brian J Mallette DPM LLC
• Colleen Patricia Briand, NP-C

• Infectious Disease Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Infectious Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.