NPIMap

Organization Active NPI

Brevard Health Alliance Inc

  • Federally Qualified Health Center (FQHC)
  • Palm Bay, FL
National Provider Identifier
1992750962
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BREVARD HEALTH ALLIANCE INC
Practice address
5270 Babcock St NE
Suite 1
Palm Bay, FL 32905-8630
Phone
(321) 722-5959
NPI assigned
May 24, 2006
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Angela Craig
Title
Billing Director
Phone
(321) 241-6834

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

5270 Babcock St NE
Suite 1
Palm Bay, FL 32905-8630

Mailing address

PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 722-5910

Other identifiers 1

IdentifierTypeStateIssuer
688693100MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060609000218 FL Part A Provider - Federally Qualified Health Center (FQHC) 0446201768 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rockledge, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992750962. Details of each certification follow.

Federally qualified health center certification: CCN 101986

Legal name
BREVARD HEALTH ALLIANCE INC
Doing business as
CENTRAL COUNTY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 29, 2006
Last certification
Jun 29, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Apr 1, 2003 in FL
Enrollment address
220 Barton Blvd
Unit C14
Rockledge, FL 32955-2742

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

220 Barton Blvd
#C14
Rockledge, FL 32955
Phone (321) 639-5177

220 Barton Blvd
Ste C14
Rockledge, FL 32955

519 Penn Ave
Ste 2
Turtle Creek, PA 15145
Phone (412) 349-0632

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Robert Santiago Individual Corporate DirectorBoard Member Aug 1, 2019
Lena Marie Knapp Individual Corporate DirectorBoard Member Nov 1, 2018
Brett Esrock Individual Corporate DirectorBoard Member Aug 1, 2017
Barry Forbes Individual Corporate DirectorBoard Member May 1, 2021
Colleen Browne Individual Corporate DirectorBoard Member Mar 1, 2020
Erin Shea Individual Corporate DirectorBoard Member Nov 1, 2018
Kevin Hill Individual Corporate DirectorBoard Member Feb 1, 2011
Richard a Helton Individual Corporate OfficerCeo Jun 1, 2016
Corporate DirectorCeo Jan 1, 2020
W-2 Managing EmployeeCeo Jun 1, 2016
Leigh Pettigrew Individual Corporate DirectorBoard Member May 1, 2020
Keith Donald Individual Corporate DirectorBoard Member Oct 1, 2018
Synthia Michelle Doaks Individual Corporate DirectorBoard Member May 1, 2022
Mike Young Individual Corporate DirectorBoard Member Nov 1, 2006

Practitioners & affiliated clinicians

Practitioners 77

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.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1992750962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "321-722-5910",
            "fax_number": "321-733-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5270 BABCOCK ST NE",
            "address_2": "SUITE 1",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329058630",
            "telephone_number": "321-722-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD HEALTH ALLIANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "321-241-6834"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688693100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

Verify at the official NPI Registry.