Active NPI
Leavitt Medical Associates of Florida Inc
- Dermatology Physician
- Jupiter, FL
National Provider Identifier
1043478522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- Practice address
- 2101 US Highway 1
Jupiter, FL 33477-7321 - Phone
- (561) 748-0510
- Fax
- (561) 748-0598
- NPI assigned
- May 30, 2008
- Organization subpart
- Yes
- Parent organization
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nefrita Logan
- Title
- Pro Ser Rep
- Phone
- (407) 875-2080
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary | ||
| MOHS-Micrographic Surgery Physician | 207ND0101X | |||
| Family Medicine Physician | 207Q00000X | |||
| Plastic Surgery Physician | 208200000X |
Addresses
Primary practice location
2101 US Highway 1
Jupiter, FL 33477-7321
Mailing address
2600 Lake Lucien Dr
Suite 180
Maitland, FL 32751-7233
Phone (407) 875-2080
Other names 1
- Advanced Dermatology and Cosmetic Sur
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider Directory- Part of
- Leavitt Medical Associates of Florida Inc
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dermatology Physician
- Vero Beach, FL
- NPI 1386627867
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212105600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1271808000000",
"number": "1043478522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 LAKE LUCIEN DR",
"address_2": "SUITE 180",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327517233",
"telephone_number": "407-875-2080",
"fax_number": "407-875-0518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 US HIGHWAY 1",
"city": "JUPITER",
"state": "FL",
"postal_code": "334777321",
"telephone_number": "561-748-0510",
"fax_number": "561-748-0598"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
"enumeration_date": "2008-05-30",
"last_updated": "2010-04-21",
"status": "A",
"authorized_official_last_name": "LOGAN",
"authorized_official_first_name": "NEFRITA",
"authorized_official_title_or_position": "PRO SER REP",
"authorized_official_telephone_number": "407-875-2080"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
},
{
"code": "207ND0101X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Plastic Surgery",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Dermatology and Cosmetic Sur",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Jupiter, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.