Individual provider Active NPI

Brian M Rebori, DC

  • Chiropractor
  • Largo, FL
National Provider Identifier
1306972641
Registry record updated Jun 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH0009206 Issued in FL
Practice address
11444 Seminole Blvd
Largo, FL 33778
Phone
(727) 393-6100
Fax
(727) 393-5461
NPI assigned
Feb 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH9206 FL
Chiropractor 111N00000X CH0009206 FL Primary

Addresses

Primary practice location

11444 Seminole Blvd
Largo, FL 33778

Mailing address

11444 Seminole Blvd
Largo, FL 33778
Phone (727) 393-6100

Other identifiers 1

IdentifierTypeStateIssuer
76115OtherBCBS FL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070416000279 FL Practitioner - Chiropractic 7113022427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hollstrom and Associates IncGroup PAC ID 6406942572, 2 clinicians

Practice addresses (Care Compare)

11444 Seminole Blvd
Largo, FL 33778-3237
Phone (727) 393-6100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH0009206FLMDChiropractor
CH9206FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiromed Chiropractic Center, Inc Chiropractor Past Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

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": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245628800000",
    "number": "1306972641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11444 SEMINOLE BLVD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "33778",
            "telephone_number": "727-393-6100",
            "fax_number": "727-393-5461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11444 SEMINOLE BLVD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "33778",
            "telephone_number": "727-393-6100",
            "fax_number": "727-393-5461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REBORI",
        "first_name": "BRIAN",
        "middle_name": "M",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2009-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9206",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH0009206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "76115",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.