NPIMap

Organization Active NPI

Central Brevard Anesthesiologists, PA

  • Anesthesiology Physician
  • Rockledge, FL
National Provider Identifier
1205875671
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CENTRAL BREVARD ANESTHESIOLOGISTS, PA
Practice address
110 Longwood Ave
Attn: 2ND Floor Operating Room
Rockledge, FL 32955
Phone
(321) 637-2616
Fax
(321) 637-2986
NPI assigned
Jun 4, 2006
Last updated
Nov 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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

Authorized official

Name
Andrea Orphanos, MDNPI 1447298997
Title
President
Phone
(321) 637-2616

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU
Anesthesiology Physician 207L00000X NU Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU

Addresses

Primary practice location

110 Longwood Ave
Attn: 2ND Floor Operating Room
Rockledge, FL 32955

Mailing address

P.O. Box 561420
Rockledge, FL 32956
Phone (321) 637-2616

Other identifiers 2

IdentifierTypeStateIssuer
24916OtherFLBCBS
375517700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000796 FL Part B Supplier - Clinic/Group Practice 3577477314 Receives reassigned benefits from 40 practitioners
Practice locations: Melbourne, FL; Merritt Island, FL; Rockledge, FL

National Provider Directory

National Provider Directory

Locations

230 S Courtenay Pkwy
Merritt Island, FL 32952
Phone (321) 452-9799

110 Longwood Ave
Fl 2
Rockledge, FL 32955
Phone (321) 637-2616

Practitioners & affiliated clinicians

Practitioners 99

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.

View all 99

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1205875671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 561420",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "32956",
            "telephone_number": "321-637-2616",
            "fax_number": "321-637-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LONGWOOD AVE",
            "address_2": "ATTN: 2ND FLOOR OPERATING ROOM",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "32955",
            "telephone_number": "321-637-2616",
            "fax_number": "321-637-2986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL BREVARD ANESTHESIOLOGISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "ORPHANOS",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-637-2616",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "24916",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375517700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockledge, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; 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.