Individual provider Active NPI

Tobi Lea Patrick, MD

  • Family Medicine Physician
  • Rockledge, FL
National Provider Identifier
1366011066
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME164850 Issued in FL
Practice address
220 Barton Blvd Unit C-14
Rockledge, FL 32955-2742
Phone
(321) 241-6800
Fax
(321) 241-6890
NPI assigned
Jun 18, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME164850 FL Primary

Addresses

Primary practice location

220 Barton Blvd Unit C-14
Rockledge, FL 32955-2742

Mailing address

PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 952-9696

Other practice location 1

1301 Hodges Dr
Tallahassee, FL 32308-4614
Phone (850) 431-5430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240918001549 FL Practitioner - Family Practice 2668851031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brevard Health Alliance IncGroup PAC ID 0446201768, 50 clinicians

Practice addresses (Care Compare)

220 Barton Blvd
Unit C 14
Rockledge, FL 32955-2742
Phone (321) 241-6800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME164850FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Health Alliance, Inc. CurrentSince Aug 19, 2024 Accepting new patients
Brevard Health Alliance Inc CurrentSince Aug 19, 2024 Accepting new patients
Brevard Health Alliance Inc Current Accepting new patients
Brevard Health Alliance Inc Past Accepting new patients

Locations

2120 Sarno Rd
Melbourne, FL 32935
Phone (321) 952-9696

220 Barton Blvd
Unit C14
Rockledge, FL 32955
Phone (321) 639-5177

Organizations & group practices 4

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": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1366011066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "321-952-9696",
            "fax_number": "321-952-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BARTON BLVD UNIT C-14",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552742",
            "telephone_number": "321-241-6800",
            "fax_number": "321-241-6890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Hodges Dr",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323084614",
            "country_code": "US",
            "telephone_number": "850-431-5430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "TOBI",
        "middle_name": "LEA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-18",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME164850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockledge, FL

Sources for this page

Verify at the official NPI Registry.