Basil C Theodotou MD PA

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

ME0046303 Issued in FL

Legal business name

BASIL C THEODOTOU MD PA

Practice address

32 Suntree PL
Melbourne, FL 32940-7689

Phone

(321) 752-7001

Fax

(321) 254-1776

NPI assigned

Dec 6, 2011

Organization subpart

No

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

Authorized official

Name

Basil Theodotou, MDNPI 1760487961

Title

Owner

Phone

(321) 752-7001

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Basil Theodotou, M.D.

  • Neurological Surgery Physician
  • Melbourne, FL
  • NPI 1760487961
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1323129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483574400000",
    "number": "1235407206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 SUNTREE PL",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407689",
            "telephone_number": "321-752-7001",
            "fax_number": "321-254-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 SUNTREE PL",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407689",
            "telephone_number": "321-752-7001",
            "fax_number": "321-254-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASIL C THEODOTOU MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-06",
        "last_updated": "2017-01-05",
        "status": "A",
        "authorized_official_last_name": "THEODOTOU",
        "authorized_official_first_name": "BASIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-752-7001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": "ME0046303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041713100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Nicole Bartlett, APRN
• Susan Barto
• Kaylyn Hope Barton
• Natalie Margaret Bartos, RD, LD
• Hazel Fajardo Basa, RN
• Thanesseri Baskaran, MD
• Bassem Eldaif MD PA (Center for Advanced Urology & Robotics)
• Kimberly Melissa Bates, ARNP
• Nicole M Batiste, MSW
• James W. Battaglini, M.D.

• Neurological Surgery Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Neurological Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; 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.