NPIMap

Organization Active NPI

Brevard Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Melbourne, FL
National Provider Identifier
1770528838
Registry record updated Jul 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
PH13979 Issued in FL
Legal business name
BREVARD SURGERY CENTER
Practice address
665 S Apollo Blvd
Melbourne, FL 32901-1485
Phone
(321) 984-3200
Fax
(321) 984-2620
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2022

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

Authorized official

Name
Robyn A McDaniel, CPA
Title
Director of Finance
Phone
(321) 821-7446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X PH13979 FL Primary

Addresses

Primary practice location

665 S Apollo Blvd
Melbourne, FL 32901-1485

Mailing address

665 S Apollo Blvd
Melbourne, FL 32901-1485
Phone (321) 984-3200

Other identifiers 3

IdentifierTypeStateIssuer
64EOtherFLBCBS
079180600MedicaidFL
490002578OtherFLMEDICARE ID TYPE UNSPECIFIED

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070501000202 FL Part B Supplier - Ambulatory Surgical Center 3173629532 Receives reassigned benefits from 1 practitioner
Practice locations: Melbourne, FL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Brevard Surgery CenterCCN 10C0001219
Medicare certification status
ActiveFrom the Provider of Services file

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
10D0911030Brevard Surgery Center665 Apollo Blvd, Melbourne, FL 32901Certificate of waiverJan 23, 2028

National Provider Directory

National Provider Directory

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": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656979200000",
    "number": "1770528838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 S APOLLO BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011485",
            "telephone_number": "321-984-3200",
            "fax_number": "321-984-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 S APOLLO BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011485",
            "telephone_number": "321-984-3200",
            "fax_number": "321-984-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "321-821-7446",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "PH13979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "64E",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079180600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID TYPE UNSPECIFIED",
            "identifier": "490002578",
            "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 5, 2022; 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.