NPIMap

Organization Active NPI

North Brevard Medical Support, Inc

  • Gastroenterology Physician
  • Titusville, FL
National Provider Identifier
1184398828
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
NORTH BREVARD MEDICAL SUPPORT, INC
Practice address
825 Century Medical Dr Ste a
Titusville, FL 32796-2113
Phone
(321) 268-6224
Fax
(321) 268-6229
NPI assigned
Aug 5, 2021
Last updated
Aug 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Authorized official

Name
Kent Andrew Bailey
Title
VP Finance
Phone
(321) 268-6111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

825 Century Medical Dr Ste a
Titusville, FL 32796-2113

Mailing address

805 Century Medical Dr Ste C
Titusville, FL 32796-2100
Phone (321) 268-6834

National Provider Directory

National Provider Directory
Tax ID family
North Brevard Medical S13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

825 Century Medical Dr
Ste A
Titusville, FL 32796
Phone (321) 268-6868

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1184398828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 CENTURY MEDICAL DR STE C",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962100",
            "telephone_number": "321-268-6834",
            "fax_number": "321-268-6272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 CENTURY MEDICAL DR STE A",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962113",
            "telephone_number": "321-268-6224",
            "fax_number": "321-268-6229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BREVARD MEDICAL SUPPORT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "321-268-6111"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.