Active NPI
Bsa LLC
- Surgery Physician
- Melbourne, FL
National Provider Identifier
1851344063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- ME56101
- Legal business name
- BSA LLC
- Practice address
- 1140 Broadband Dr
Melbourne, FL 32901-2623 - Phone
- (321) 733-1901
- Fax
- (321) 733-0211
- NPI assigned
- May 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Emran Riaz Imami, M.D.
- Title
- Owner Physician
- Phone
- (321) 733-1901
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | ME56101 | FL | Primary |
Addresses
Primary practice location
1140 Broadband Dr
Melbourne, FL 32901-2623
Mailing address
PO Box 33428
Indialantic, FL 32903-0428
Phone (321) 733-1901
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370625700 | Medicaid | FL | |
| 15274 | Other | FL | BLUE CROSS |
Other names 1
- Brevard Surgical Associates TEPAS Healthcare
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050131000500 | FL | Part B Supplier - Clinic/Group Practice | 5496705188 |
Receives reassigned benefits from 6 practitioners Practice locations: Melbourne, FL |
National Provider Directory
National Provider Directory- Tax ID family
- Bsa LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Nurse Practitioner
- Melbourne, FL
- NPI 1548626880
Practitioners & affiliated clinicians
Practitioners 6
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": "1147910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1334102400000",
"number": "1851344063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 33428",
"city": "INDIALANTIC",
"state": "FL",
"postal_code": "329030428",
"telephone_number": "321-733-1901",
"fax_number": "321-733-0211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 BROADBAND DR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329012623",
"telephone_number": "321-733-1901",
"fax_number": "321-733-0211"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BSA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-18",
"last_updated": "2012-04-11",
"status": "A",
"authorized_official_last_name": "IMAMI",
"authorized_official_first_name": "EMRAN",
"authorized_official_middle_name": "RIAZ",
"authorized_official_title_or_position": "OWNER PHYSICIAN",
"authorized_official_telephone_number": "321-733-1901",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": "FL",
"license": "ME56101",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "370625700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "15274",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Brevard Surgical Associates TEPAS Healthcare",
"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 Apr 11, 2012; 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.