NPIMap

Organization Active NPI

Skin Dermatology and Cosmetic Services, P.a.

  • Dermatology Physician
  • Palm Coast, FL
National Provider Identifier
1003582123
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SKIN DERMATOLOGY AND COSMETIC SERVICES, P.A.
Practice address
84 Pinnacles Dr Ste 400
Palm Coast, FL 32164-2324
Phone
(386) 256-1969
Fax
(407) 599-7506
NPI assigned
Aug 18, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shawna Frame
Title
Billing Manager
Phone
(423) 525-5993

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

84 Pinnacles Dr Ste 400
Palm Coast, FL 32164-2324

Mailing address

865 Saxon Blvd
Orange City, FL 32763-8204
Phone (386) 256-1969

Other identifiers 1

IdentifierTypeStateIssuer
009563608MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL rwheeler@rcwheelermd.ezderm.info

National Provider Directory

National Provider Directory
Tax ID family
Skin Dermatology and Cosmetic Services PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

865 Saxon Blvd
Orange City, FL 32763
Phone (386) 256-1969

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1003582123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 SAXON BLVD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638204",
            "telephone_number": "386-256-1969",
            "fax_number": "407-599-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 PINNACLES DR STE 400",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321642324",
            "telephone_number": "386-256-1969",
            "fax_number": "407-599-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN DERMATOLOGY AND COSMETIC SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "FRAME",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "423-525-5993"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009563608",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "rwheeler@rcwheelermd.ezderm.info",
            "affiliation": "N",
            "address_1": "84 Pinnacles Dr Ste 400",
            "city": "Palm Coast",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321642324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.