NPIMap

Organization Active NPI

Pediatrics in Brevard, P.a.

  • Pediatrics Physician
  • Melbourne, FL
National Provider Identifier
1619968245
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRICS IN BREVARD, P.A.
Practice address
1755 W Hibiscus Blvd
Melbourne, FL 32901-2616
Phone
(321) 724-5437
Fax
(321) 724-5570
NPI assigned
Nov 2, 2005
Last updated
Jul 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Authorized official

Name
Melissa Loiselle
Title
Credentialing Coordinator
Phone
(321) 877-4438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1755 W Hibiscus Blvd
Melbourne, FL 32901-2616

Mailing address

1755 W Hibiscus Blvd
Melbourne, FL 32901-2616
Phone (321) 724-5437

Other identifiers 1

IdentifierTypeStateIssuer
253255701MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Pediatrics in Brevard PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1755 W Hibiscus Blvd
Melbourne, FL 32901
Phone (321) 724-5437

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1619968245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 W HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012616",
            "telephone_number": "321-724-5437",
            "fax_number": "321-724-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 W HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012616",
            "telephone_number": "321-724-5437",
            "fax_number": "321-724-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS IN BREVARD, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "LOISELLE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "321-877-4438"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253255701",
            "state": "FL"
        }
    ],
    "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 Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.