Individual provider Active NPI

Naomi Plack

  • Anesthesiologist Assistant
  • Melbourne, FL
National Provider Identifier
1891517322
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
Practice address
2627 W Eau Gallie Blvd Ste 101
Melbourne, FL 32935-8303
Phone
(321) 837-3820
NPI assigned
Oct 28, 2024
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X Primary

Addresses

Primary practice location

2627 W Eau Gallie Blvd Ste 101
Melbourne, FL 32935-8303

Mailing address

N1637 Highway 67
Neosho, WI 53059-9645

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250225001415 FL Practitioner - Anesthesiology Assistant 1557881216 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brevard Physician Associates PLLCGroup PAC ID 1850535048, 221 clinicians

Practice addresses (Care Compare)

1350 Hickory St
Melbourne, FL 32901-3224
Phone (321) 434-7000

Hospital & facility affiliations

  • Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
  • Palm Bay Hospital Hospital, Palm Bay, FL, CCN 100316
  • Cape Canaveral Hospital Hospital, Cocoa Beach, FL, CCN 100177
  • Viera Hospital Hospital, Melbourne, FL, CCN 100315

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Physician Associates, PLLC Anesthesiologist Assistant CurrentSince Mar 1, 2025 Accepting new patients
Brevard Physician Associates, PLLC PastSince Nov 3, 2024 Accepting new patients

Locations

701 W Cocoa Beach Cswy
Cocoa Beach, FL 32931
Phone (321) 799-7111

2627 W Eau Gallie Blvd
Ste 101
Melbourne, FL 32935
Phone (321) 802-6859

1350 Hickory St
Melbourne, FL 32901
Phone (321) 434-1771

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1891517322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N1637 HIGHWAY 67",
            "city": "NEOSHO",
            "state": "WI",
            "postal_code": "530599645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 W EAU GALLIE BLVD STE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358303",
            "telephone_number": "321-837-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLACK",
        "first_name": "NAOMI",
        "sole_proprietor": "NO",
        "sex": "U",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 28, 2024; 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.