BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC (NPI# 1164716676) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164716676 |
| Entity Type | Organization |
| Organization Name | BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC |
| Other Organization Name | THE BACK CENTER |
| Practice Address |
2222 S Harbor City Blvd Suite 510 Melbourne FL 32901-5594 |
| Mailing Address |
2222 S Harbor City Blvd Suite 610 Melbourne FL 32901-5594 |
| Practice Telephone | 3217237716 |
| Practice Fax Number | 3217230604 |
| Mailing Telephone | 3217237716 |
| Mailing Fax Number | 3217230604 |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-06-01 |
| Authorized Official Name | CATHLEEN BIRD (ADMINISTRATOR) |
| Authorized Official Telephone | 3217237716 |
| Is Organization Subpart | Y |
| Parent Organization Name | BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2471M1202X |
Radiologic Technologist Specialization: Magnetic Resonance Imaging |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 247100000X | Radiologic Technologist | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 040225700 | 05 | |
| FL | MEDICARE | 99949 | 01 |
| Other Name | Type Code |
|---|---|
| The BACK Center | Doing Business As Name - Organization |
| Street Address |
2222 S HARBOR CITY BLVD SUITE 510 |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901-5594 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639163975 | Neuroskeletal Imaging LLC | Radiology | 2222 S Harbor City Blvd, Melbourne, FL 32901-5591 | 2005-09-01 |
| 1164897575 | Anesthesiology Consultants of Melbourne, Pa | Anesthesiology | 2222 S Harbor City Blvd, #610, Melbourne, FL 32901-5594 | 2015-12-10 |
| 1346662103 | Casey W Langel | Physician Assistant | 2222 S Harbor City Blvd, Suite 610, Melbourne, FL 32901-5594 | 2014-01-14 |
| 1528406402 | Jessica Herraiz | Nurse Practitioner | 2222 S Harbor City Blvd, Ste 610, Melbourne, FL 32901-5591 | 2013-06-12 |
| 1285988279 | Amanda Ann Folkers | Physician Assistant | 2222 S Harbor City Blvd, Suite 610, Melbourne, FL 32901-5594 | 2012-10-30 |
| 1295013415 | Brevard Hma Hme, LLC | Durable Medical Equipment & Medical Supplies | 2222 S Harbor City Blvd, Suite 630, Melbourne, FL 32901-5594 | 2011-07-22 |
| 1003100504 | Brevard Orthopaedic Spine & Pain Clinic Inc | Chiropractor | 2222 S Harbor City Blvd, Suite 530, Melbourne, FL 32901-5594 | 2011-06-02 |
| 1518259050 | Osler Hma Medical Group LLC | Chiropractor | 2222 S Harbor City Blvd, Suite 420, Melbourne, FL 32901-5594 | 2011-05-03 |
| 1790014942 | Evangelia Fotopoulos | Family Medicine | 2222 S Harbor City Blvd, Suite 430, Melbourne, FL 32901-5594 | 2009-12-17 |
| 1528393857 | Aliyah Hamirani | Physical Therapist | 2222 S Harbor City Blvd, Suite 530, Melbourne, FL 32901-5527 | 2009-10-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062943 | George Pappas | Anesthesiologist Assistant | 1775 W. Hibiscus Blvd., Ste 215, Melbourne, FL 32901 | 2020-08-09 |
| 1124676820 | Abbi Dell Lee | Behavioral Analyst | 3251 Engineering St, Melbourne, FL 32901 | 2019-08-27 |
| 1750856878 | Jeffrey Michael Cavanagh | Behavior Technician | 3251 Engineering Street, Melbourne, FL 32901 | 2018-10-04 |
| 1740766021 | Amanda Miller | Behavior Technician | 1885 W Hibiscus Blvd, Melbourne, FL 32901 | 2018-07-19 |
| 1396244406 | Dragen II LLC | Urology | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901 | 2018-02-03 |
| 1225550692 | Cabrit Psychotherapy Services LLC | Marriage & Family Therapist | 100 Rialto Place, Suite 700, Melbourne, FL 32901 | 2017-07-07 |
| 1487188058 | Project Response, Inc. | Clinic/Center | 747 S. Apollo Boulevard, Melbourne, FL 32901 | 2017-04-20 |
| 1184174575 | Paulette Swanson | Physical Therapist | 611 East Sheridan Rd, Melbourne, FL 32901 | 2016-10-10 |
| 1841747839 | Nicholas Wilson | Social Worker | 3661 S. Babcock St., Melbourne, FL 32901 | 2016-09-07 |
| 1467804278 | Nickolas Hetherington | Occupational Therapist | 1900 S Harbor City Blvd Ste 108, Melbourne, FL 32901 | 2016-07-05 |
| Find all providers in zip 32901 | ||||
| Taxonomy Code | 247100000X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528504016 | Alexander Sanchez | Radiologic Technologist | 1600 Sarno Rd, Suite 15, Melbourne, FL 32935-4938 | 2017-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932672540 | All Injury & Diagnostic Clinic LLC | Radiologic Technologist | 125 Mason Ave Ste A, Daytona Beach, FL 32117-5017 | 2019-01-07 |
| 1134675036 | Luis Raul Rodriguez | Radiologic Technologist | 9056 Sw 148th Ct, Miami, FL 33196-4119 | 2016-08-30 |
| 1003362211 | Jeanette Christine Gillespie | Radiologic Technologist | 1357 Hillside Dr., Tarpon Springs, FL 34689-2011 | 2016-08-28 |
| 1366996670 | Jennifer Tzigos | Radiologic Technologist | 2586 Windwood Dr, Clearwater, FL 33763-1254 | 2016-08-04 |
| 1033566112 | Lori Ganim | Radiologic Technologist | 10000 Bay Pines Blvd North, St Petersburg, FL 33708 | 2016-05-19 |
| 1629432695 | Emmanuel Jose | Radiologic Technologist | 1489 N Military Trl Ste 217, West Palm Beach, FL 33409-6057 | 2016-04-06 |
| 1942672860 | Julia Mcdaniel | Radiologic Technologist | 1420 Lantry Ct, Orlando, FL 32804-1220 | 2015-10-30 |
| 1548638521 | Regional Medical Imaging, Inc | Radiologic Technologist | 7475 Nw 4th St, Plantation, FL 33317-2227 | 2015-09-09 |
| 1750764387 | Jennifer Lynn Howell | Radiologic Technologist | 5901 Broken Sound Parkway #450, Boca Raton, FL 33487-2787 | 2015-07-01 |
| 1164817367 | Gang Qiu | Radiologic Technologist | 8090 Atlantic Blvd Apt G92, Jacksonville, FL 32211-8573 | 2015-04-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.