Organization Active NPI

C and C Healthcare LLC

  • General Practice Physician
  • Melbourne, FL
National Provider Identifier
1568851632
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
C AND C HEALTHCARE LLC
Practice address
101 E Florida Ave
Melbourne, FL 32901-8301
Phone
(321) 984-4600
NPI assigned
Jan 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Authorized official

Name
Maria Dejesus
Title
Office Manager
Phone
(321) 615-1417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

101 E Florida Ave
Melbourne, FL 32901-8301

Mailing address

PO Box 410654
Melbourne, FL 32941-0654
Phone (321) 615-1417

Other practice location 1

1420 South Oak Street
Melbourne, FL 32901-3113
Phone (321) 615-1417

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150327000385 FL Part B Supplier - Clinic/Group Practice 4587981758 Receives reassigned benefits from 1 practitioner
Practice locations: Melbourne, FL

National Provider Directory

National Provider Directory
Tax ID family
C and C Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1420 Oak St
Melbourne, FL 32901
Phone (321) 326-2300

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1568851632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410654",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329410654",
            "telephone_number": "321-615-1417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E FLORIDA AVE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329018301",
            "telephone_number": "321-984-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1420 South Oak Street",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329013113",
            "country_code": "US",
            "telephone_number": "321-615-1417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "C AND C HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "DEJESUS",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "321-615-1417"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 31, 2024; 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.