NPIMap

Organization Active NPI

Restore Health Management LLC

  • Urgent Care Clinic/Center
  • Palm Bay, FL
National Provider Identifier
1609240779
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
RESTORE HEALTH MANAGEMENT LLC
Practice address
1840 Eldron Blvd SE
Suite 1
Palm Bay, FL 32909-6871
Phone
(321) 312-4580
Fax
(321) 914-4053
NPI assigned
Nov 30, 2015
Last updated
Apr 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

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

Authorized official

Name
Michael Husted
Title
Clinic Manager
Phone
(321) 312-4580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1840 Eldron Blvd SE
Suite 1
Palm Bay, FL 32909-6871

Mailing address

1840 Eldron Blvd SE
Suite 1
Palm Bay, FL 32909-6871
Phone (321) 312-4580

Other names 1

  • Restore Health Urgent Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160420002026 FL Part B Supplier - Clinic/Group Practice 4688972896 Receives reassigned benefits from 20 practitioners
Practice locations: Palm Bay, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2105381Restore Health Urgent Care1840 Eldron Blvd, SE Ste 1, Palm Bay, FL 32909Certificate of waiverNov 23, 2027

National Provider Directory

National Provider Directory

Locations

1840 Eldron Blvd SE
Ste 1
Palm Bay, FL 32909
Phone (321) 312-4580

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1609240779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 ELDRON BLVD SE",
            "address_2": "SUITE 1",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096871",
            "telephone_number": "321-312-4580",
            "fax_number": "321-914-4053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 ELDRON BLVD SE",
            "address_2": "SUITE 1",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096871",
            "telephone_number": "321-312-4580",
            "fax_number": "321-914-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE HEALTH MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-30",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "HUSTED",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "321-312-4580"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restore Health Urgent Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.