NPIMap

Organization Active NPI

Brandon Psychiatric Group LLC

  • Behavioral Neurology & Neuropsychiatry Physician
  • Brandon, FL
National Provider Identifier
1952710147
Registry record updated Feb 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
License
95351 Issued in FL
Legal business name
BRANDON PSYCHIATRIC GROUP LLC
Practice address
106 W Windhorst Rd
Brandon, FL 33510-2455
Phone
(678) 923-6025
NPI assigned
Aug 13, 2014
Last updated
Feb 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2019

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

Authorized official

Name
Dr. Hany Botros Mikhail, M.D.NPI 1013014737
Title
President
Phone
(678) 923-6025

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)CodeLicenseStatePrimary
Behavioral Neurology & Neuropsychiatry Physician 2084B0040X 95351 FL Primary

Addresses

Primary practice location

106 W Windhorst Rd
Brandon, FL 33510-2455

Mailing address

PO Box 1584
Cumming, GA 30028-1584
Phone (678) 923-6025

Other identifiers 1

IdentifierTypeStateIssuer
275940302MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161206001729 FL Part B Supplier - Clinic/Group Practice 5092095240 Receives reassigned benefits from 7 practitioners
Practice locations: Brandon, FL

National Provider Directory

National Provider Directory

Locations

106 W Windhorst Rd
Brandon, FL 33510
Phone (678) 923-6025

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549411200000",
    "number": "1952710147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1584",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300281584",
            "telephone_number": "678-923-6025",
            "fax_number": "813-413-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 W WINDHORST RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335102455",
            "telephone_number": "678-923-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON PSYCHIATRIC GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2019-02-06",
        "status": "A",
        "authorized_official_last_name": "MIKHAIL",
        "authorized_official_first_name": "HANY",
        "authorized_official_middle_name": "BOTROS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-923-6025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "FL",
            "license": "95351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275940302",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.

Verify at the official NPI Registry.