Brevard Medical Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BREVARD MEDICAL DERMATOLOGY, PA

Practice address

7960 N. Wickham Road
Suite 103
Melbourne, FL 32940-8096

Phone

(321) 428-4737

Fax

(321) 241-6457

NPI assigned

Nov 18, 2014

Last updated

Feb 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Spicer, MDNPI 1831176858

Title

President

Phone

(321) 428-4737

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 13

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.

• Michael Stewart Spicer, MD

  • Dermatology Physician
  • Viera, FL
  • NPI 1831176858
  Medicare reassignment Care Compare group NPD Authorized official
• Nadine B Acri, MD

  • Procedural Dermatology Physician
  • Melbourne, FL
  • NPI 1306835681
  Medicare reassignment Care Compare group NPD
• Christina Ann M Asch, ARNP BC

  • Nurse Practitioner
  • Titusville, FL
  • NPI 1225014384
  Medicare reassignment Care Compare group NPD
• Christine M Cooke, P.A.-C

  • Physician Assistant
  • Merritt Island, FL
  • NPI 1235150004
  Medicare reassignment Care Compare group
• Justin Fitz, PA-C

  • Procedural Dermatology Physician
  • Melbourne, FL
  • NPI 1386933570
  Medicare reassignment Care Compare group
• Alexandra Forrest

  • Physician Assistant
  • Melbourne, FL
  • NPI 1568102598
  Medicare reassignment Care Compare group
• Kristine C Hertzog, PA

  • Medical Physician Assistant
  • Titusville, FL
  • NPI 1750546040
  Medicare reassignment Care Compare group
• Morgan Jackson, PA-C

  • Physician Assistant
  • Merritt Island, FL
  • NPI 1073075453
  Medicare reassignment Care Compare group
• Anna Elizabeth Whittington, PA-C

  • Medical Physician Assistant
  • Melbourne, FL
  • NPI 1568700490
  Medicare reassignment Care Compare group
• Rodolfo E. Chirinos, MD

  • Dermatology Physician
  • Hollywood, FL
  • NPI 1255535431
  Medicare reassignment NPD
• Alexandra Grammenos, DO

  • Dermatology Physician
  • Melbourne, FL
  • NPI 1477059590
  Medicare reassignment NPD
• Jennifer Lynn North

  • Family Nurse Practitioner
  • Melbourne, FL
  • NPI 1205103884
  Medicare reassignment NPD

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

{
    "created_epoch": "1416268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582243200000",
    "number": "1649676669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7960 N. WICKHAM ROAD",
            "address_2": "SUITE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408096",
            "telephone_number": "321-428-4737",
            "fax_number": "321-241-6457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7960 N. WICKHAM ROAD",
            "address_2": "SUITE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408096",
            "telephone_number": "321-428-4737",
            "fax_number": "321-241-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD MEDICAL DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-18",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A",
        "authorized_official_last_name": "SPICER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-428-4737",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brevard Hma HME, LLC (Wuesthoff Home Medical Equipment)
• Brevard Hma HME, LLC (Wuesthoff Home Medical Equipment)
• Brevard Home Care LLC (Griswold Homecare)
• Brevard Hope Center
• Brevard Hyperbarics LLC
• Brevard Neuro Center
• Brevard Optometry Associates (Brevard Vision Care)
• Brevard Orthopaedic Spine & Pain Clinic Inc (The BACK Center)
• Brevard Orthopaedic Spine & Pain Clinic Inc (The BACK CENTER)
• Brevard Orthopaedics Spine & Pain Clinic, Inc (The BACK Center)

• Dermatology Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; 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.