NPIMap

Individual provider Active NPI

Steven Spake, RBT

  • Behavior Technician
  • Melbourne, FL
National Provider Identifier
1225542111
Registry record updated Nov 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
18-66850 Issued in FL
Practice address
125 E Nasa Blvd
Melbourne, FL 32901
Phone
(321) 372-6813
Fax
(321) 765-6434
NPI assigned
Nov 30, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X 18-66850 FL Primary

Addresses

Primary practice location

125 E Nasa Blvd
Melbourne, FL 32901

Mailing address

125 E Nasa Blvd
Melbourne, FL 32901-1900
Phone (321) 372-6813

Other practice location 1

550 Solutions Way
Rockledge, FL 32955-3620
Phone (321) 639-9800

Other practice location 2

2180 Julian Ave NE
Palm Bay, FL 32905-4020
Phone (321) 372-6813

Other identifiers 1

IdentifierTypeStateIssuer
023114600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
18-66850FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Behavior Services of Brevard County Past Accepting new patients
Kaleidoscope Interventions Past Accepting new patients
Behavior Services of Brevard, Inc. Behavior Technician Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1225542111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E NASA BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011900",
            "telephone_number": "321-372-6813",
            "fax_number": "321-765-6434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E NASA BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "321-372-6813",
            "fax_number": "321-765-6434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 Solutions Way",
            "address_purpose": "LOCATION",
            "city": "Rockledge",
            "state": "FL",
            "postal_code": "329553620",
            "country_code": "US",
            "telephone_number": "321-639-9800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2180 Julian Ave NE",
            "address_purpose": "LOCATION",
            "city": "Palm Bay",
            "state": "FL",
            "postal_code": "329054020",
            "country_code": "US",
            "telephone_number": "321-372-6813",
            "fax_number": "321-765-6434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPAKE",
        "first_name": "STEVEN",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-30",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "18-66850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023114600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; 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.