NPIMap

Organization Active NPI

Brevard Orthopaedic Spine & Pain Clinic Inc

Doing business as The BACK CENTER

  • Orthopaedic Surgery Physician
  • Melbourne, FL
National Provider Identifier
1548237100
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC
Doing business as
The BACK CENTER
Practice address
2222 S. Harbor City Blvd
Suite 610
Melbourne, FL 32901-5591
Phone
(321) 723-7716
Fax
(321) 723-0604
NPI assigned
Mar 2, 2006
Last updated
Jul 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Authorized official

Name
Richard A Hynes, MDNPI 1184697450
Title
President
Phone
(321) 541-1537

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU
Orthopaedic Surgery Physician 207X00000X NU Primary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X NU
Physical Therapist 225100000X NU

Addresses

Primary practice location

2222 S. Harbor City Blvd
Suite 610
Melbourne, FL 32901-5591

Mailing address

2222 S. Harbor City Blvd
Suite 610
Melbourne, FL 32901-5591
Phone (321) 723-7716

Other identifiers 1

IdentifierTypeStateIssuer
040225700MedicaidFL

Other names 1

  • The BACK CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040603001297 FL Part B Supplier - Clinic/Group Practice 8628050515 Receives reassigned benefits from 11 practitioners
Practice locations: Melbourne, FL

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1071 Port Malabar Blvd NE
Palm Bay, FL 32905
Phone (321) 698-9310

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1548237100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 S. HARBOR CITY BLVD",
            "address_2": "SUITE 610",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015591",
            "telephone_number": "321-723-7716",
            "fax_number": "321-723-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 S. HARBOR CITY BLVD",
            "address_2": "SUITE 610",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015591",
            "telephone_number": "321-723-7716",
            "fax_number": "321-723-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-02",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "HYNES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-541-1537",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040225700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The BACK CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The BACK CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.