Active NPI
Paul Bucolo, MD
- Family Medicine Physician
- New Smyrna Beach, FL
National Provider Identifier
1871633719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME143433
- Practice address
- 125 Florida Memorial Pkwy Ste 2200
New Smyrna Beach, FL 32168-9309 - Phone
- (386) 409-6839
- Fax
- (386) 409-6916
- NPI assigned
- Feb 8, 2007
- Last updated
- Apr 10, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3476 | FL | |
| Family Medicine Physician | 207Q00000X | PA3476 | FL | |
| Family Medicine Physician | 207Q00000X | ME143433 | FL | Primary |
Addresses
Primary practice location
125 Florida Memorial Pkwy Ste 2200
New Smyrna Beach, FL 32168-9309
Mailing address
250 Harrison St
Titusville, FL 32780-5094
Phone (321) 268-6868
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 290408000 | Medicaid | FL |
Other names 1
- Dr. Paul J. Bucolo
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
250 Harrison St
Titusville, FL 32780-5094
Phone (321) 268-6834
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME143433 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Brevard Medical Support, Inc | Current | Accepting new patients |
Locations
250 Harrison St
Titusville, FL 32780
Phone (321) 268-6868
805 Century Medical Dr
Ste C
Titusville, FL 32796
Phone (321) 268-6264
951 N Washington Ave
Titusville, FL 32796
Phone (302) 325-5511
Interoperability endpoints
- paul.bucolo.1@17832.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Parrish Medical Group
- Multi-Specialty Clinic/Center
- Titusville, FL
- NPI 1609834886
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Health First Home Care
- Home Health Agency
- Melbourne, FL
- NPI 1922006956
-
dba Parrish Medical Center
- General Acute Care Hospital
- Titusville, FL
- NPI 1053424648
-
dba AdventHealth New Smyrna Beach
- General Acute Care Hospital
- New Smyrna Beach, FL
- NPI 1871977942
-
- General Acute Care Hospital
- Melbourne, FL
- NPI 1730494816
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681084800000",
"number": "1871633719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 HARRISON ST",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327805094",
"telephone_number": "321-268-6868",
"fax_number": "321-267-2713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 FLORIDA MEMORIAL PKWY STE 2200",
"city": "NEW SMYRNA BEACH",
"state": "FL",
"postal_code": "321689309",
"telephone_number": "386-409-6839",
"fax_number": "386-409-6916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCOLO",
"first_name": "PAUL",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2023-04-10",
"certification_date": "2023-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "3476",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "PA3476",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME143433",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "290408000",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PAUL",
"last_name": "BUCOLO",
"middle_name": "J.",
"prefix": "DR.",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in New Smyrna Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.