BREVARD HEALTH ALLIANCE (NPI# 1619026218) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619026218 |
| Entity Type | Organization |
| Organization Name | BREVARD HEALTH ALLIANCE |
| Practice Address |
17 Silver Palm Ave Melbourne FL 32901-3123 |
| Mailing Address |
Po Box 1137 Melbourne FL 32902-1137 |
| Practice Telephone | 3217332021 |
| Practice Fax Number | 3217270884 |
| Mailing Telephone | 3219529696 |
| Mailing Fax Number | 3219527937 |
| Enumeration Date | 2007-01-10 |
| 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 | 6886931-03 | 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 |
| 1518017896 | Brevard Health Alliance | Clinic/Center | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2007-01-11 |
| 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 |
17 SILVER PALM AVE |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901-3123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568454486 | Lynette M Graff | Family Medicine | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2005-08-17 |
| 1063929479 | Michael Griffin | Nurse Practitioner | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2018-01-08 |
| 1316101264 | Obaydah Ahmad Abdurraqeeb | Family Medicine | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2008-07-10 |
| 1336306240 | Chandra Mangra | Family Medicine | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2008-05-19 |
| 1689868622 | Charles Eugene Potts | Internal Medicine | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2007-09-04 |
| 1528115458 | Brevard Health Alliance Inc | Clinic/Center | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2007-01-04 |
| 1598704066 | Hui Ping Chang | Nurse Practitioner | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2006-06-06 |
| 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 | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083180434 | The Brevard Health Alliance, Inc. | Clinic/Center | 2120 Sarno Rd, Melbourne, FL 32935-3084 | 2018-10-23 |
| 1902244486 | Brevard Health Alliance Inc | Clinic/Center | 2120 Sarno Rd, Melbourne, FL 32935-3084 | 2013-06-06 |
| 1013355726 | Brevard Health Alliance Inc | Clinic/Center | 2120 Sarno Rd, Melbourne, FL 32935-3084 | 2013-06-05 |
| 1831442938 | Arcare | Clinic/Center | 54 Tate Springs Rd, Melbourne, AR 72556-8633 | 2012-10-26 |
| 1528115458 | Brevard Health Alliance Inc | Clinic/Center | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2007-01-04 |
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| 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.