NPIMap

Organization Active NPI

North Brevard Medical Support, Inc

  • Obstetrics & Gynecology Physician
  • Port St John, FL
National Provider Identifier
1295409928
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NORTH BREVARD MEDICAL SUPPORT, INC
Practice address
5005 Port St John Pkwy Ste 2200
Port St John, FL 32927-4305
Phone
(321) 633-8663
Fax
(321) 633-8618
NPI assigned
Aug 5, 2021
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
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

5005 Port St John Pkwy Ste 2200
Port St John, FL 32927-4305

Mailing address

805 Century Medical Dr Ste C
Titusville, FL 32796-2100
Phone (321) 268-6264

National Provider Directory

National Provider Directory
Tax ID family
North Brevard Medical13 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.

Practitioners & affiliated clinicians

Practitioners 5

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

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": "1295409928",
    "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": "321-268-6264",
            "fax_number": "321-268-6273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 PORT ST JOHN PKWY STE 2200",
            "city": "PORT ST JOHN",
            "state": "FL",
            "postal_code": "329274305",
            "telephone_number": "321-633-8663",
            "fax_number": "321-633-8618"
        }
    ],
    "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": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St John, 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.