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  5. BREVARD PAIN MANAGEMENT, INC.

BREVARD PAIN MANAGEMENT, INC. - Florida Company Profile

Company Details

Entity Name: BREVARD PAIN MANAGEMENT, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

BREVARD PAIN MANAGEMENT, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 15 May 1985 (40 years ago)
Date of dissolution: 11 Apr 2018 (7 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 11 Apr 2018 (7 years ago)
Document Number: M15413
FEI/EIN Number 592565845

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940, US
Mail Address: 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940, US
ZIP code: 32940
County: Brevard
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1346251022 2006-08-10 2010-10-25 PO BOX 129, TITUSVILLE, FL, 327810129, US 1832 GARDEN ST, TITUSVILLE, FL, 327963200, US

Contacts
Phone +1 321-264-1961
Fax 3212640472

Authorized person
Name DR. TODD B JAFFE
Role PRESIDENT
Phone 3217570577

Taxonomy
Taxonomy Code 207LA0401X - Addiction Medicine (Anesthesiology) Physician
Is Primary No
Taxonomy Code 207LP2900X - Pain Medicine (Anesthesiology) Physician
Is Primary Yes

Other Provider Identifiers
Issuer RAILROAD MEDICARE PTAN
Number CM3459
State FL
Issuer MEDICAID
Number 0692212-00
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BREVARD PAIN MANAGEMENT, INC. PROFIT SHARING PLAN 2016 592565845 2017-06-12 BREVARD PAIN MANAGEMENT, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-05-13
Business code 621399
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940
BREVARD PAIN MANAGEMENT, INC. PROFIT SHARING PLAN 2015 592565845 2016-05-10 BREVARD PAIN MANAGEMENT, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-05-13
Business code 621399
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940
BREVARD PAIN MANAGEMENT INC 401 K PROFIT SHARING PLAN TRUST 2015 592565845 2016-05-20 BREVARD PAIN MANAGEMENT INC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446190
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2016-05-20
Name of individual signing ALICIA SAVOIE
Valid signature Filed with authorized/valid electronic signature
BREVARD PAIN MANAGEMENT, INC. PROFIT SHARING PLAN 2014 592565845 2015-08-24 BREVARD PAIN MANAGEMENT, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-05-13
Business code 621399
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2015-08-24
Name of individual signing TODD JAFFE
Valid signature Filed with authorized/valid electronic signature
BREVARD PAIN MANAGEMENT INC 401 K PROFIT SHARING PLAN TRUST 2014 592565845 2015-05-19 BREVARD PAIN MANAGEMENT INC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446190
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8905 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2015-05-19
Name of individual signing ALICIA SAVOIE
Valid signature Filed with authorized/valid electronic signature
BREVARD PAIN MANAGEMENT, INC. PROFIT SHARING PLAN 2013 592565845 2014-09-12 BREVARD PAIN MANAGEMENT, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-05-13
Business code 621399
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2014-09-12
Name of individual signing TODD JAFFE
Valid signature Filed with authorized/valid electronic signature
BREVARD PAIN MANAGEMENT INC 401 K PROFIT SHARING PLAN TRUST 2013 592565845 2014-05-21 BREVARD PAIN MANAGEMENT INC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446190
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8905 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2014-05-21
Name of individual signing ALICIA SAVOIE
Valid signature Filed with authorized/valid electronic signature
BREVARD PAIN MANAGEMENT INC 401 K PROFIT SHARING PLAN TRUST 2012 592565845 2013-07-08 BREVARD PAIN MANAGEMENT INC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446190
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8905 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2013-07-08
Name of individual signing BREVARD PAIN MANAGEMENT INC
Valid signature Filed with authorized/valid electronic signature
BREVARD PAIN MANAGEMENT, INC. PROFIT SHARING PLAN 2012 592565845 2013-06-28 BREVARD PAIN MANAGEMENT, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-05-13
Business code 621399
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2013-06-28
Name of individual signing TODD JAFFE
Valid signature Filed with authorized/valid electronic signature
BREVARD PAIN MANAGEMENT INC 401 K PROFIT SHARING PLAN TRUST 2011 592565845 2012-07-25 BREVARD PAIN MANAGEMENT INC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446190
Sponsor’s telephone number 3217570577
Plan sponsor’s address 8905 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940

Plan administrator’s name and address
Administrator’s EIN 592565845
Plan administrator’s name BREVARD PAIN MANAGEMENT INC
Plan administrator’s address 8905 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940
Administrator’s telephone number 3217570577

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing BREVARD PAIN MANAGEMENT INC
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
Flavin, Nooney and Person CPA's Agent 304 SOUTH HARBOR CITY BLVD, MELBOURNE, FL, 32901
JAFFE TODD B President 8095 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940
JAFFE TODD B Secretary 8095 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940
JAFFE TODD B Director 8095 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940
JAFFE SHIRLEY R Vice President 8095 SPYGLASS HILL ROAD, MELBOURNE, FL, 32940

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2018-04-11 - -
REGISTERED AGENT NAME CHANGED 2017-04-27 Flavin, Nooney and Person CPA's -
CHANGE OF PRINCIPAL ADDRESS 2011-04-15 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL 32940 -
CHANGE OF MAILING ADDRESS 2011-04-15 8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL 32940 -
REGISTERED AGENT ADDRESS CHANGED 2004-01-26 304 SOUTH HARBOR CITY BLVD, STE 201, MELBOURNE, FL 32901 -
NAME CHANGE AMENDMENT 1994-05-19 BREVARD PAIN MANAGEMENT, INC. -
NAME CHANGE AMENDMENT 1992-09-22 S.C.P.B. PAIN MANAGEMENT, INC. -
AMENDED AND RESTATEDARTICLES 1985-05-23 - -

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J20000206355 ACTIVE 2020 10315 CIDL VOLUSIA CNTY, FL/ONONDAGA, NY 2019-09-30 2025-04-28 $127959.39 BANKERS HEALTHCARE GROUP, LLC, 201 SOLAR ST., SYRACUSE, NY 13204

Documents

Name Date
VOLUNTARY DISSOLUTION 2018-04-11
ANNUAL REPORT 2017-04-27
ANNUAL REPORT 2016-03-26
ANNUAL REPORT 2015-02-12
ANNUAL REPORT 2014-03-20
ANNUAL REPORT 2013-04-16
ANNUAL REPORT 2012-04-11
ANNUAL REPORT 2011-04-15
ANNUAL REPORT 2010-04-08
ANNUAL REPORT 2009-03-09

Companies related by officers

JAFFE TODD B

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Domestic Profit (2019 - 2020)

JAFFE SHIRLEY R

ROYAL FOUR HOTEL, INCORPORATED. - Inactive
Domestic Profit (1978 - 1999)

Companies related by address

8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940, US

SHIROJA, L.L.C.

8095 SPYGLASS HILL ROAD, SUITE 101, MELBOURNE, FL, 32940, US

SHIROJA, L.L.C.

Date of last update: 01 Apr 2025

Sources: Florida Department of State

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