Brevard Primary Care LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

BREVARD PRIMARY CARE LLC

Practice address

2328 Citadel Way Ste 103-319
Melbourne, FL 32940-6459

Phone

(321) 757-1900

Fax

(866) 376-2481

NPI assigned

Jun 26, 2014

Organization subpart

No

Name

Dr. Bhavani M Puskur, M.D.NPI 1760453427

Title

Practice Owner

Phone

(321) 948-8555

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

• Bhavani Puskur, MD

  • Infectious Disease Physician
  • Melbourne, FL
  • NPI 1760453427

  FL, Internal Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Amy Jagdmann

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1184268856

  FL

  Medicare reassignment Care Compare group NPD
• Christina Ruthann Mattes, APRN

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1316719685

  FL

  Medicare reassignment Care Compare group NPD
• Kimberly Havens, APRN

  • Nurse Practitioner
  • Viera, FL
  • NPI 1336713965

  FL

  Medicare reassignment Care Compare group
• Eliza Charles

  • Family Nurse Practitioner
  • Palm Bay, FL
  • NPI 1245098425

  FL

  Medicare reassignment
• Pushpa Daliya, APRN

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1841761673

  FL

  Medicare reassignment

Medicare fee-for-service enrollment

Enrolled in FL

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 15, 2024.

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1376958462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2328 CITADEL WAY STE 103-319",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329406459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2328 CITADEL WAY STE 103-319",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329406459",
            "telephone_number": "321-757-1900",
            "fax_number": "866-376-2481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "PUSKUR",
        "authorized_official_first_name": "BHAVANI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "321-948-8555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brevard Pathology PA
• Brevard Pathology Services PA
• Brevard Physical Therapy LLC
• Brevard Physician Associates, PLLC
• Brevard Physician Associates, PLLC
• Brevard Prosthetics & Orthotics, Inc
• Brevard Psychiatry & Psychology Inc
• Brevard Psychiatry LLC
• Brevard Psychiatry LLC
• Brevard Psychological Associates, Inc

• All providers in Melbourne, FL
• Infectious Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.