Individual provider Active NPI

Porsha Butler, M.D.

  • Pediatrics Physician
  • Rockledge, FL
National Provider Identifier
1427437664
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME140891 Issued in FL
Practice address
220 Barton Blvd Unit C-14
Rockledge, FL 32955-2742
Phone
(321) 639-5177
Fax
(321) 639-4927
NPI assigned
May 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X ME140891 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 identifiers 1

IdentifierTypeStateIssuer
102963000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20260106003903 AR Practitioner - Pediatric Medicine 8426367921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Morehouse School of Medicine, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

225 E Washington Ave
Jonesboro, AR 72401-3111

6100 Waterford District Dr
Suite 450
Miami, FL 33126-2037

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME140891FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Bernards Hospital Inc. CurrentSince Jan 1, 2026 Accepting new patients

Locations

1201 Fleming Ave
Jonesboro, AR 72401
Phone (870) 932-0440

225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1427437664",
    "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": "321-639-5177",
            "fax_number": "321-639-4927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "PORSHA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-20",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME140891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102963000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockledge, FL

Sources for this page

Verify at the official NPI Registry.