NPIMap

Organization Active NPI

Brevard Internal Medicine & Walk-in Clinic

  • Primary Care Clinic/Center
  • W Melbourne, FL
National Provider Identifier
1710216262
Registry record updated Feb 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
ME97764 Issued in FL
Legal business name
BREVARD INTERNAL MEDICINE & WALK-IN CLINIC
Practice address
2795 W New Haven Ave
W Melbourne, FL 32904-3705
Phone
(321) 622-8626
Fax
(321) 622-8627
NPI assigned
Dec 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2014

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

Authorized official

Name
Dr. Aravind Kumar, MDNPI 1871539072
Title
Sole Owner
Phone
(321) 622-8626

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X ME97764 FL Primary
Primary Care Clinic/Center 261QP2300X ARNP 2107012 FL

Addresses

Primary practice location

2795 W New Haven Ave
W Melbourne, FL 32904-3705

Mailing address

PO Box 411685
Melbourne, FL 32941-1685
Phone (321) 622-8626

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100318000081 FL Part B Supplier - Clinic/Group Practice 9133254980 Receives reassigned benefits from 6 practitioners
Practice locations: West Melbourne, FL

National Provider Directory

National Provider Directory

Locations

2795 W New Haven Ave
West Melbourne, FL 32904
Phone (321) 372-1765

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
10D2003646Brevard Internal Medicine and Walk in Clinic2795 W New Haven Ave, West Melbourne, FL 32904Certificate of waiverFeb 15, 2028

NPI Registry JSON

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

{
    "created_epoch": "1260489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391731200000",
    "number": "1710216262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411685",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329411685",
            "telephone_number": "321-622-8626",
            "fax_number": "321-622-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2795 W NEW HAVEN AVE",
            "city": "W MELBOURNE",
            "state": "FL",
            "postal_code": "329043705",
            "telephone_number": "321-622-8626",
            "fax_number": "321-622-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD INTERNAL MEDICINE & WALK-IN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-11",
        "last_updated": "2014-02-07",
        "status": "A",
        "authorized_official_last_name": "KUMAR",
        "authorized_official_first_name": "ARAVIND",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "321-622-8626",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME97764",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ARNP 2107012",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in W Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; 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.