Southside Dermatology, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME16473 Issued in FL

Legal business name

SOUTHSIDE DERMATOLOGY, P.A.

Practice address

4727 Sunbeam Rd
Suite 101
Jacksonville, FL 32257-6107

Phone

(904) 880-0622

Fax

(904) 880-0623

NPI assigned

May 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Mary Trinh Pentel, M.D.NPI 1588677058

Title

President

Phone

(904) 880-0622

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Trinh Pentel, M.D.

  • Dermatology Physician
  • Jacksonville, FL
  • NPI 1588677058
  Medicare reassignment Care Compare group Authorized official
• Carmen Josefa Ramirez-Boyd, CRFNP

  • Nurse Practitioner
  • Jacksonville, FL
  • NPI 1730345943
  Medicare reassignment Care Compare group NPD
• Khaai Tran Nguyen, PA-C

  • Physician Assistant
  • St Augustine, FL
  • NPI 1861222911
  Medicare reassignment Care Compare group
• Erin Olivia Wade, PA-C

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1811769029
  Medicare reassignment Care Compare group
• Mary Parker Davidson, FNP-C

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1881424380
  Medicare reassignment NPD
• Julia Clarkson, ARNP

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1811440837
  NPD (past)
• Kristin Mary Doyle, APRN

  • Family Nurse Practitioner
  • Jacksonville Beach, FL
  • NPI 1871100354
  NPD (past)
• Debbie Gloria, ARNP

  • Adult Health Nurse Practitioner
  • Fernandina Beach, FL
  • NPI 1902819931
  NPD (past)
• Julia Nguyen

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1902792146
  NPD (past)

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404259200000",
    "number": "1023276607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4727 SUNBEAM RD",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576107",
            "telephone_number": "904-880-0622",
            "fax_number": "904-880-0623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4727 SUNBEAM RD",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576107",
            "telephone_number": "904-880-0622",
            "fax_number": "904-880-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2014-07-02",
        "status": "A",
        "authorized_official_last_name": "PENTEL",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "TRINH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-880-0622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME16473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southpoint Surgery Center, LLC
• Southside Aspen PLLC
• Southside Counseling Biofeedback & Stress Management Center, Inc
• Southside Counseling Biofeedback and Stress Management Center
• Southside Counselling Center LLC
• Southside Family Practice &Womens Health PA
• Southwest Jacksonville Dialysis Center LLC (Normandy Village Dialysis Center)
• Southwood Nursing Center
• Lauryn Souvenir
• Alyssa Souza

• Specialist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.