NPIMap

Organization Active NPI

Presgar Imaging of Rockledge LLC

Doing business as South Brevard Imaging

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Melbourne, FL
National Provider Identifier
1558348680
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
License
HCC4831 Issued in FL
Legal business name
PRESGAR IMAGING OF ROCKLEDGE LLC
Doing business as
South Brevard Imaging
Practice address
1327 Oak St
Melbourne, FL 32901-3110
Phone
(321) 729-1449
Fax
(321) 722-4270
NPI assigned
Dec 29, 2005
Last updated
Oct 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Authorized official

Name
Robbie Robertson
Title
President and Ceo
Phone
(813) 323-2594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X HCC4831 FL Primary

Addresses

Primary practice location

1327 Oak St
Melbourne, FL 32901-3110

Mailing address

23110 State Rd 54
PMB 292
Lutz, FL 33549-2921
Phone (352) 578-2055

Other identifiers 1

IdentifierTypeStateIssuer
257947200MedicaidFL

Other names 1

  • South Brevard Imaging Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080105000041 FL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9739151903 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rockledge, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

23110 State Road 54
Lutz, FL 33549
Phone (727) 808-7123

1327 Oak St
Melbourne, FL 32901
Phone (321) 729-1149

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1558348680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23110 STATE RD 54",
            "address_2": "PMB 292",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335492921",
            "telephone_number": "352-578-2055",
            "fax_number": "813-971-0818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 OAK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013110",
            "telephone_number": "321-729-1449",
            "fax_number": "321-722-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESGAR IMAGING OF ROCKLEDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "ROBBIE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "813-323-2594"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "FL",
            "license": "HCC4831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257947200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Brevard Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Brevard Imaging",
            "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 Oct 28, 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.