BREVARD HEALTH ALLIANCE (NPI# 1518017896) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518017896 |
| Entity Type | Organization |
| Organization Name | BREVARD HEALTH ALLIANCE |
| Practice Address |
220 Barton Blvd Unit C14 Rockledge FL 32955-2742 |
| Mailing Address |
Po Box 1137 Melbourne FL 32902-1137 |
| Practice Telephone | 3216395177 |
| Practice Fax Number | 3216394927 |
| Mailing Telephone | 3219529696 |
| Mailing Fax Number | 3219527937 |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2016-08-17 |
| Authorized Official Name | ANGELA CRAIG (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 3212416834 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 6886931-07 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952451239 | Brevard Health Alliance | Clinic/Center | 15 Rosa L Jones Blvd, Cocoa, FL 32922-7899 | 2007-01-11 |
| 1679622120 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne # St1, Palm Bay, FL 32905-8630 | 2007-01-10 |
| 1528330826 | Brevard Health Alliance | Clinic/Center | 775 Malabar Rd, Malabar, FL 32950-3120 | 2012-02-01 |
| 1336444637 | Brevard Health Alliance | Clinic/Center | 500 N Washington Ave, Suite 105, Titusville, FL 32796-2759 | 2011-01-18 |
| 1174674956 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne # St1, Palm Bay, FL 32905-8630 | 2007-01-16 |
| 1619026218 | Brevard Health Alliance | Clinic/Center | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2007-01-10 |
| 1992750962 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne, Suite 1, Palm Bay, FL 32905-8630 | 2006-05-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BREVARD HEALTH ALLIANCE, INC., THE | 5270 Babcock St Ne Ste 1, Palm Bay, FL 32905-4616 |
| Street Address |
220 BARTON BLVD UNIT C14 |
| City | ROCKLEDGE |
| State | FL |
| Zip Code | 32955-2742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144289620 | Khaled A Mohamed | Family Medicine | 220 Barton Blvd, Unit C#14, Rockledge, FL 32955-2742 | 2006-03-22 |
| 1437772118 | Sarah Funaro | Dentist | 220 Barton Blvd, Rockledge, FL 32955-2742 | 2020-05-28 |
| 1639555766 | Catherine Casey | Social Worker | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2015-07-30 |
| 1467868570 | Kimberly Torres | Nurse Practitioner | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2014-07-09 |
| 1184964132 | Avril Asson | Nurse Practitioner | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2013-02-27 |
| 1639413925 | Brevard Health Alliance Inc | Clinic/Center | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2012-11-27 |
| 1730423021 | Brevard Health Alliance Inc | Clinic/Center | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2012-11-27 |
| 1043567639 | Laura Marie Mendoza | Family Medicine | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2012-08-14 |
| 1578824421 | Justin Conrad Koenitzer | Psychologist | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2012-06-06 |
| 1306157706 | Hagen V. Hastings | Dentist | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2010-06-30 |
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|---|---|---|---|---|
| 1477169571 | Health First Medical Group LLC | Orthopaedic Surgery | 6525 3rd Street, #302, Rockledge, FL 32955 | 2020-09-23 |
| 1063037810 | Endo Now LLC | Internal Medicine | 5460 Village Drive,viera, Rockledge, FL 32955 | 2020-06-08 |
| 1588285100 | Enrique Technologies & Trading, LLC | Meals | 1841 Long Iron Dr. Ste. 805, Rockledge, FL 32955 | 2020-05-05 |
| 1578101549 | Ericka Marshall | Counselor | 7095 Turner Road, Rockledge, FL 32955 | 2019-12-20 |
| 1174168322 | Brevard Pharmacy L.L.C. | Pharmacy | 401. Barton Blvd., Rockledge, FL 32955 | 2019-11-12 |
| 1770131443 | Fyzical Therapy & Balance Center Rockledge-viera | Clinic/Center | 634 Barnes Boulevard, Unit 202, Rockledge, FL 32955 | 2019-08-27 |
| 1699261461 | Brookview Manor Assisted Living Facility LLC | Assisted Living Facility | 882 Brookview Ln, Rockledge, FL 32955 | 2018-07-05 |
| 1750888970 | Kaitlin Donovan | Dentist | 5380 Stadium Pkwy Ste 119, Rockledge, FL 32955 | 2018-04-13 |
| 1376041327 | Serina Eder | Acupuncturist | 5595 Schenck Ave Ste 7, Rockledge, FL 32955 | 2018-01-24 |
| 1427563394 | Suntree Orthopedics, LLC | Orthopaedic Surgery | 6525 3rd St Ste 302-303, Rockledge, FL 32955 | 2017-12-13 |
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| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639413925 | Brevard Health Alliance Inc | Clinic/Center | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2012-11-27 |
| 1730423021 | Brevard Health Alliance Inc | Clinic/Center | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2012-11-27 |
| 1952459059 | Brevard Health Alliance Inc | Clinic/Center | 220 Barton Blvd, Unit #c14, Rockledge, FL 32955-2742 | 2007-01-08 |
| 1134276074 | Brevard Health Alliance Inc | Clinic/Center | 220 Barton Blvd, Unit #c14, Rockledge, FL 32955-2742 | 2007-01-04 |
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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.