NPIMap

Organization Active NPI

Nemours Children's Health, Palm Bay, Primary Care

  • Pediatrics Physician
  • Palm Bay, FL
National Provider Identifier
1629647896
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NEMOURS CHILDREN'S HEALTH, PALM BAY, PRIMARY CARE
Practice address
600 Malabar Rd SE Ste 2
Palm Bay, FL 32907-3105
Phone
(407) 237-9000
NPI assigned
Jun 22, 2021
Organization subpart
Yes
Parent organization
CHILDREN'S HEALTH ALLIANCE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
Robert Bridges
Title
Evp, Operations
Phone
(904) 697-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

600 Malabar Rd SE Ste 2
Palm Bay, FL 32907-3105

Mailing address

10140 Centurion Pkwy N
Jacksonville, FL 32256-0532

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
10D2085369Nemours Children's Health600 Malabar Rd SE Suite 2, Palm Bay, FL 32907Certificate of waiverOct 12, 2026

National Provider Directory

National Provider Directory
Tax ID family
Nemours Children's Health Maitland Primary Care21 organizations share this tax ID, including this one
Part of
Nemours Children's Health Maitland Primary Care

Other organizations with this tax ID 20

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

View all 20

Locations

600 Malabar Rd SE
Ste 2
Palm Bay, FL 32907
Phone (321) 802-6590

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1624320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1629647896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10140 CENTURION PKWY N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MALABAR RD SE STE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329073105",
            "telephone_number": "407-237-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEMOURS CHILDREN'S HEALTH, PALM BAY, PRIMARY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S HEALTH ALLIANCE, LLC",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "BRIDGES",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EVP, OPERATIONS",
        "authorized_official_telephone_number": "904-697-4000"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.