NPIMap

Organization Active NPI

D Badolato PA

  • Family Medicine Physician
  • Melbourne, FL
National Provider Identifier
1659316941
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
D BADOLATO PA
Practice address
6300 N Wickham Rd
Suite 101
Melbourne, FL 32940-2028
Phone
(321) 253-2169
Fax
(321) 253-1720
NPI assigned
Jun 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Authorized official

Name
Dr. David Badolato, MDNPI 1194728121
Title
Physician/Owner
Phone
(321) 253-2169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

6300 N Wickham Rd
Suite 101
Melbourne, FL 32940-2028

Mailing address

6300 N Wickham Rd
Suite 101
Melbourne, FL 32940-2028
Phone (321) 253-2169

Other names 1

  • Premier Urgent CareBadolato Family Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041027000662 FL Part B Supplier - Clinic/Group Practice 1557322286 Receives reassigned benefits from 9 practitioners
Practice locations: Melbourne, FL
O20100930098603 FL DME Supplier - Physician - Family PracticeDME Supplier - Sports Medicine 1557322286 Practice locations: Melbourne, FL

National Provider Directory

National Provider Directory

Locations

6300 N Wickham Rd
Ste 101
Melbourne, FL 32940
Phone (321) 253-2169

Practitioners & affiliated clinicians

Practitioners 9

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": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1659316941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 N WICKHAM RD",
            "address_2": "SUITE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402028",
            "telephone_number": "321-253-2169",
            "fax_number": "321-253-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N WICKHAM RD",
            "address_2": "SUITE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402028",
            "telephone_number": "321-253-2169",
            "fax_number": "321-253-1720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D BADOLATO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "BADOLATO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "321-253-2169",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Urgent CareBadolato Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 28, 2009; 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.