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MEDICAL ASSOCIATES OF BREVARD, LLC - Florida Company Profile

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Company Details

Entity Name: MEDICAL ASSOCIATES OF BREVARD, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 21 Jul 2004 (21 years ago)
Last Event: CORPORATE MERGER
Event Date Filed: 03 May 2005 (20 years ago)
Document Number: L04000054279
FEI/EIN Number 593360315
Address: 2200 WEST EAU GALLIE BLVD. #200, MELBOURNE, FL, 32935
Mail Address: PO BOX 361095, MELBOURNE, FL, 32936, US
ZIP code: 32935
City: Melbourne
County: Brevard
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
KANCILIA JOHN R Agent 2101 Waverly Place, Melbourne, FL, 32901
BAKSHI SHAKTI Manager 6550 WICKHAM RD, # 2, MELBOURNE, FL, 32940
GADODIA GOPAL Manager 2200 W EAU GALLIE BLVD #200, MELBOURNE, FL, 32935
PINSKY MARK Manager 8045 SPYGLASS HILL RD STE 101, MELBOURNE, FL, 32940
BANSAL PARVESH Manager 1400 PINE STREET, MELBOURNE, FL, 32901
COHEN DANIEL Manager 7730 N WICKHAM RD, MELBOURNE, FL, 32940
DEL ROSARIO LUIS Manager 1535 W. Nasa Blvd., MELBOURNE, FL, 32901

National Provider Identifier

NPI Number:
1861400103
Certification Date:
2024-02-08

Authorized Person:

Name:
GERARD L. BESSETTE
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3214350100

Form 5500 Series

Employer Identification Number (EIN):
593360315
Plan Year:
2023
Number Of Participants:
292
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
288
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
308
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
301
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
301
Sponsors Telephone Number:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000007000 BAYSIDE LAKES FAMILY CARE ACTIVE 2023-01-17 2028-12-31 - 336 COGAN DRIVE SE, PALM BAY, FL, 32909
G21000097732 NASA PRIMARY CARE ACTIVE 2021-07-27 2026-12-31 - 1555 W NASA BLVD, UNIT B1, MELBOURNE, FL, 32901
G20000100019 MELBOURNE ALLERGY & ASTHMA, P.A. ACTIVE 2020-08-07 2025-12-31 - 3140 SUNTREE BLVD, SUITE 5, ROCKLEDGE, FL, 32955
G16000087259 SPACE COAST VASCULAR ACTIVE 2016-08-16 2026-12-31 - PO BOX 361095, MELBOURNE, FL, 32936
G16000079599 VIERA PEDIATRICS ACTIVE 2016-08-03 2026-12-31 - 8095 SPYGLASS HILL RD SUITE 104, MELBOURNE, FL, 32940
G15000073874 SPYGLASS PRIMARY CARE ACTIVE 2015-07-16 2025-12-31 - 8057 SPYGLSS HILL ROAD, SUITE 104, MELBOURNE, FL, 32940
G14000024363 HANLEY SKIN CANCER CENTER ACTIVE 2014-03-10 2029-12-31 - 2200 W. EAU GALLIE BLVD, STE 202B, MELBOURNE, FL, 32935

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2022-02-17 2200 WEST EAU GALLIE BLVD. #200, MELBOURNE, FL 32935 -
REGISTERED AGENT ADDRESS CHANGED 2022-02-17 2101 Waverly Place, Suite 100, Melbourne, FL 32901 -
MERGER 2005-05-03 - CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000052349

Documents

Name Date
ANNUAL REPORT 2024-02-16
ANNUAL REPORT 2023-03-07
ANNUAL REPORT 2022-02-17
AMENDED ANNUAL REPORT 2021-03-03
ANNUAL REPORT 2021-03-01
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-02-07
ANNUAL REPORT 2018-02-12
ANNUAL REPORT 2017-02-23
ANNUAL REPORT 2016-03-08

Paycheck Protection Program

Jobs Reported:
265
Initial Approval Amount:
$3,208,952
Date Approved:
2020-04-10
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$3,208,952
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$3,251,827.16
Servicing Lender:
TD Bank, National Association
Use of Proceeds:
Payroll: $3,208,952

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Date of last update: 03 Aug 2025

Sources: Florida Department of State