MEDICAL ASSOCIATES OF BREVARD LLC (NPI# 1174531321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174531321 |
| Entity Type | Organization |
| Organization Name | MEDICAL ASSOCIATES OF BREVARD LLC |
| Other Organization Name | MEDICAL ASSOCIATES OF BREVARD, P.A. |
| Practice Address |
910 Malabar Rd Se Suite 2 Palm Bay FL 32907-3200 |
| Practice Telephone | 3217682356 |
| Practice Fax Number | 3217266388 |
| Mailing Telephone | 3217682356 |
| Mailing Fax Number | 3217266388 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-09-26 |
| Authorized Official Name | GERARD L. BESSETTE (ADMINISTRATOR) |
| Authorized Official Telephone | 3217289657 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDICAL ASSOCIATES OF BREVARD LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Medical Associates of Brevard, P.A. | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770821688 | Medical Associates of Brevard LLC | Clinic/Center | 6080 S. Babcock St. Se, Palm Bay, FL 32909-3921 | 2013-01-28 |
| 1639189251 | Medical Associates of Brevard LLC | Clinic/Center | 901 Jordan Blass Dr, Suite 103, Melbourne, FL 32940-1824 | 2006-08-08 |
| 1679582605 | Medical Associates of Brevard LLC | Clinic/Center | 580 N Wickham Rd, Suite A, Melbourne, FL 32935-8400 | 2006-08-07 |
| 1992128508 | Medical Associates of Brevard LLC | Clinic/Center | 2290 W Eau Gallie Blvd, Suite 110, Melbourne, FL 32935-3133 | 2014-02-03 |
| 1538582366 | Medical Associates of Brevard LLC | Clinic/Center | 575 S Wickham Rd, Suite A, West Melbourne, FL 32904-1170 | 2014-01-30 |
| 1639592561 | Medical Associates of Brevard LLC | Clinic/Center | 575 S Wickham Rd, Suite A, Melbourne, FL 32904-1170 | 2014-01-29 |
| 1942570098 | Medical Associates of Brevard LLC | Internal Medicine | 8045 Spyglass Hill Road, Suite 102, Melbourne, FL 32940-8567 | 2012-01-06 |
| 1053689810 | Medical Associates of Brevard LLC | Internal Medicine | 1301 W Eau Gallie Blvd Ste 108, Melbourne, FL 32935-5390 | 2011-12-08 |
| 1538476726 | Medical Associates of Brevard LLC | Obstetrics & Gynecology | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901-1382 | 2010-09-09 |
| 1689987596 | Medical Associates of Brevard LLC | Internal Medicine | 397 N Wickham Rd, Suite 101, Melbourne, FL 32935-8669 | 2010-07-20 |
| Street Address |
910 MALABAR RD SE SUITE 2 |
| City | PALM BAY |
| State | FL |
| Zip Code | 32907-3200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861497158 | Michael John Ayres | Podiatrist | 910 Malabar Rd Se, Ste 1, Palm Bay, FL 32907-3200 | 2005-06-15 |
| 1033389200 | Michael J. Ayres, Dpm, Pa | Durable Medical Equipment & Medical Supplies | 910 Malabar Rd Se, Suite #1, Palm Bay, FL 32907-3200 | 2008-03-04 |
| 1811074529 | Tara Christine Buck | Nurse Practitioner | 910 Malabar Rd Se, Suite 2, Palm Bay, FL 32907-3200 | 2006-11-01 |
| 1124023890 | Ming Tao Lai | Family Medicine | 910 Malabar Rd Se, Ste 2, Palm Bay, FL 32907-3200 | 2005-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861015109 | Tyreak Albert Mclarty | Behavior Technician | 2180 Julian Ave Nw, Palm Bay, FL 32907 | 2020-05-21 |
| 1871073759 | Jessica Elizabeth Ford | Physical Therapist | 470 Malabar Rd Se Unit 102, Palm Bay, FL 32907 | 2018-08-20 |
| 1598264558 | Corey Williams | Case Management | 1850 Delki St. Nw, Palm Bay, FL 32907 | 2018-02-06 |
| 1386154904 | Lauren Nicole Meek | Social Worker | 550 Malabar Rd Sw Apt 202, Palm Bay, FL 32907 | 2017-10-10 |
| 1679002877 | Kandice Monique Hearns | Physical Therapy Assistant | 175 Ne Villa Nueva Ave, Palm Bay, FL 32907 | 2017-06-09 |
| 1780113076 | Caring Manor LLC | Assisted Living Facility | 1863 Edith St Ne, Palm Bay, FL 32907 | 2017-06-08 |
| 1467992107 | Enrique Martinez | Counselor | 1510 Studley Dr. Nw, Palm Bay, FL 32907 | 2017-02-28 |
| 1144776469 | Stephanie Ann Hoenig | Physical Therapy Assistant | 1155 Malabar Rd Se, Palm Bay, FL 32907 | 2016-08-28 |
| 1124471529 | K & S Tender Care 11 | Assisted Living Facility | 226 Abalone Road Ne, Palm Bay, FL 32907 | 2016-07-20 |
| 1235507781 | Jai Ho LLC | Specialist | 1663 Georgia Street, Suite 400, Palm Bay, FL 32907 | 2015-09-14 |
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| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598323461 | Florida Health Care of Brevard | Clinic/Center | 1840 Eldron Blvd Se Ste 2, Palm Bay, FL 32909-6871 | 2019-06-04 |
| 1770821688 | Medical Associates of Brevard LLC | Clinic/Center | 6080 S. Babcock St. Se, Palm Bay, FL 32909-3921 | 2013-01-28 |
| 1932330743 | Medical Associates of Brevard LLC | Clinic/Center | 2186 Harris Ave Ne, Suite 2, Palm Bay, FL 32905-4044 | 2009-07-29 |
| 1285799791 | Medical Associates of Brevard LLC | Clinic/Center | 1051 Port Malabar Blvd Ne, # 9, Palm Bay, FL 32905-5153 | 2006-12-26 |
| 1013071489 | Medical Associates of Brevard LLC | Clinic/Center | 5055 Babcock St Ne, # 2, Palm Bay, FL 32905-4673 | 2006-12-20 |
| 1245248954 | Medical Associates of Brevard LLC | Clinic/Center | 1071 Port Malabar Blvd Ne, Suite 111, Palm Bay, FL 32905-5161 | 2006-08-04 |
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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.