NPIMap

Individual provider Active NPI

Clarence James Bronstema, D.O.

  • Emergency Medicine Physician
  • Melbourne, FL
National Provider Identifier
1992807150
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS9722 Issued in FL
Practice address
1350 S Hickory Street
Melbourne, FL 32901
Phone
(321) 254-6218
Fax
(321) 254-6230
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS9722 FL Primary

Addresses

Primary practice location

1350 S Hickory Street
Melbourne, FL 32901

Mailing address

PO Box 361907
Melbourne, FL 32906-1907
Phone (321) 254-6218

Other identifiers 2

IdentifierTypeStateIssuer
07270OtherFLBLUECROSS BLUESHIELD
279999500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080126000129 FL Practitioner - Emergency Medicine 9234211418 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2003
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

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS9722FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Physician Associates, PLLC Emergency Medicine CurrentSince Oct 1, 2013 Accepting new patients
Harder Emergency Physicians Emergency Medicine Past Accepting new patients
Pelican Coast Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Leeland ER SVCS Partnership LLC Emergency Medicine Past Accepting new patients
Brevard Emergency Services Emergency Medicine Past Accepting new patients
Wuesthoff Emergency Physicians PA Emergency Medicine Past Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: cbronstema71745@epicdirect.hf.org

Organizations & group practices 6

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 3

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": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1992807150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 361907",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329061907",
            "telephone_number": "321-254-6218",
            "fax_number": "321-254-6230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S HICKORY STREET",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "321-254-6218",
            "fax_number": "321-254-6230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONSTEMA",
        "first_name": "CLARENCE",
        "middle_name": "JAMES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS9722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "07270",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279999500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.