Active NPI
Bret J Macdermott, DC, DACS
- Chiropractor
- Celebration, FL
National Provider Identifier
1417035940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH9737
- Practice address
- 2940 Mallory Cir
Ste 205
Celebration, FL 34747-1818 - Phone
- (407) 507-6976
- Fax
- (888) 808-4097
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1618 | WA | |
| Chiropractor | 111N00000X | CH9737 | FL | Primary |
Addresses
Primary practice location
2940 Mallory Cir
Ste 205
Celebration, FL 34747-1818
Mailing address
2940 Mallory Cir
Ste 205
Celebration, FL 34747-1818
Phone (407) 507-6976
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C0580Z | Other | FL | MEDICARE INDIVIDUAL |
| 2201B | Other | FL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH9737 | FL | MD | Chiropractor |
Organizations & group practices 1
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.
-
- Nurse Practitioner
- Kissimmee, FL
- NPI 1689902199
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466985600000",
"number": "1417035940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2940 MALLORY CIR",
"address_2": "STE 205",
"city": "CELEBRATION",
"state": "FL",
"postal_code": "347471818",
"telephone_number": "407-507-6976",
"fax_number": "888-808-4097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2940 MALLORY CIR",
"address_2": "STE 205",
"city": "CELEBRATION",
"state": "FL",
"postal_code": "347471818",
"telephone_number": "407-507-6976",
"fax_number": "888-808-4097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACDERMOTT",
"first_name": "BRET",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DC, DACS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2016-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "1618",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH9737",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE INDIVIDUAL",
"identifier": "C0580Z",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "2201B",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Celebration, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; 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.