NPIMap

Organization Active NPI

Brevard Prosthetics & Orthotics, Inc.

  • Prosthetic/Orthotic Supplier
  • Titusville, FL
National Provider Identifier
1992840904
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
BREVARD PROSTHETICS & ORTHOTICS, INC.
Practice address
2223 S Washington Ave Ste a
Titusville, FL 32780-4703
Phone
(321) 225-8001
Fax
(321) 225-4046
NPI assigned
Feb 20, 2007
Organization subpart
Yes
Parent organization
BREVARD PROSTHETICS & ORTHOTICS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Authorized official

Name
Mr. Sumesh Saxena
Title
Member
Phone
(219) 648-2644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

2223 S Washington Ave Ste a
Titusville, FL 32780-4703

Mailing address

3803 E Lincoln Hwy
Merrillville, IN 46410-5809
Phone (219) 791-9200

Other identifiers 1

IdentifierTypeStateIssuer
009959000MedicaidFL

Other names 1

  • Brevard Prosthetics Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930040754 FL DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 1557482445 Practice locations: Titusville, FL

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Brevard Prosthetics & Orthotics Inc2223 S Washington Ave, Titusville, FL 32780-4703(321) 225-8001 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Brevard Prosthetics Orthotics Inc4 organizations share this tax ID, including this one
Part of
Brevard Prosthetics Orthotics Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2110 S Washington Ave
Ste D
Titusville, FL 32780
Phone (321) 638-0262

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679961600000",
    "number": "1992840904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 E LINCOLN HWY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105809",
            "telephone_number": "219-791-9200",
            "fax_number": "219-228-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 S WASHINGTON AVE STE A",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327804703",
            "telephone_number": "321-225-8001",
            "fax_number": "321-225-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD PROSTHETICS & ORTHOTICS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BREVARD PROSTHETICS & ORTHOTICS, INC.",
        "enumeration_date": "2007-02-20",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "SAXENA",
        "authorized_official_first_name": "SUMESH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "219-648-2644",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009959000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brevard Prosthetics Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Brevard Prosthetics Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.