Pediatric ENT, LLC

Primary specialty

Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X

License

ME90348 Issued in FL

Legal business name

PEDIATRIC ENT, LLC

Practice address

1499 S Harbor City Blvd Ste 303
Melbourne, FL 32901-3245

Phone

(321) 254-5437

Fax

(321) 254-4543

NPI assigned

Jan 5, 2009

Organization subpart

No

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

Authorized official

Name

Dr. David Joel Malis, MDNPI 1649242538

Title

Manager

Phone

(321) 254-5437

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Family ENT & Audiology Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

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

• David Joel Malis, MD

  • Pediatric Otolaryngology Physician
  • Melbourne, FL
  • NPI 1649242538
  Medicare reassignment NPD Authorized official
• Brianna Alexis Dunbar, PA-C

  • Physician Assistant
  • Stuart, FL
  • NPI 1063291227
  NPD (past)
• Shelby J Roemer, AU.D.

  • Audiologist
  • Rockledge, FL
  • NPI 1730513813
  NPD (past)

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397779200000",
    "number": "1508002072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 S HARBOR CITY BLVD STE 303",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013245",
            "telephone_number": "321-254-5437",
            "fax_number": "321-254-4543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 S HARBOR CITY BLVD STE 303",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013245",
            "telephone_number": "321-254-5437",
            "fax_number": "321-254-4543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-05",
        "last_updated": "2014-04-18",
        "status": "A",
        "authorized_official_last_name": "MALIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "321-254-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "FL",
            "license": "ME90348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID HMO - AMERIGROUP",
            "identifier": "01269821",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID HMO - UNITED HEALTH CARE",
            "identifier": "2258392",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID HMO - WELLCARE",
            "identifier": "332181",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271247400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family ENT & Audiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathy D. Pearce, PSY.D
• Joshua Aaron Pearson, PTA
• Abby Elizabeth Pease, LCSW
• Aleksander W Pecherek, DO
• Richard Pectol, NP-C
• Pediatric Health & Wellness of Brevard, PA
• Pediatric Services of America, LLC
• Pediatric Services of America, LLC
• Pediatric Services of America, LLC
• Pediatric Services of America, LLC

• Pediatric Otolaryngology Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Pediatric Otolaryngology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2014; 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.