Florida Dermatology Associates Inc

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

ME51282 Issued in FL

Legal business name

FLORIDA DERMATOLOGY ASSOCIATES INC

Doing business as

Palm Bay Dermatology

Practice address

5070 Minton Rd NW
Suite 5
Palm Bay, FL 32907-1157

Phone

(321) 768-1600

Fax

(321) 768-6418

NPI assigned

Apr 14, 2006

Last updated

Nov 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ruben Moreno, MDNPI 1225092331

Title

President

Phone

(321) 768-1600

Specialties & licenses 1

Addresses

Other names 1

• Palm Bay Dermatology Doing business as

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 20

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.

• Ruben Antenor Moreno, MD

  • MOHS-Micrographic Surgery Physician
  • Palm Bay, FL
  • NPI 1225092331
  Medicare reassignment Care Compare group NPD Authorized official
• James Michael Magill Jr., M.D.

  • Clinical Pathology/Laboratory Medicine Physician
  • Gainesville, FL
  • NPI 1073682514
  Medicare reassignment Care Compare group NPD
• Christopher John Carlisle, PA-C

  • Physician Assistant
  • Tampa, FL
  • NPI 1477559375
  Medicare reassignment Care Compare group
• Jeanette Marie Gluck, PA-C

  • Physician Assistant
  • Palm Bay, FL
  • NPI 1023072170
  Medicare reassignment Care Compare group
• Anthony Moreno, PA-C

  • Medical Physician Assistant
  • Cocoa Beach, FL
  • NPI 1356909964
  Medicare reassignment Care Compare group
• Nichole M Palomba, PA-C

  • Physician Assistant
  • Palm Bay, FL
  • NPI 1124494661
  Medicare reassignment Care Compare group
• Julianne Prete, PA-C

  • Physician Assistant
  • Melbourne, FL
  • NPI 1760969513
  Medicare reassignment Care Compare group
• Helen Gilmore Turk, PA-C

  • Medical Physician Assistant
  • Cocoa Beach, FL
  • NPI 1992065411
  Medicare reassignment Care Compare group
• Johanna Espenschied, PA-C

  • Medical Physician Assistant
  • Palm Bay, FL
  • NPI 1427474584
  Medicare reassignment NPD
• Robert Michael Taylor, M.D.

  • Dermatology Physician
  • Palm Bay, FL
  • NPI 1720189657
  Medicare reassignment NPD
• Cindy Capestany Bassford, PA-C, PHD

  • Physician Assistant
  • Boca Raton, FL
  • NPI 1770816308
  Medicare reassignment
• Daniel J Calabrese, PA-C

  • Medical Physician Assistant
  • Merritt Island, FL
  • NPI 1265763916
  Medicare reassignment

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1073577136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5070 MINTON RD NW",
            "address_2": "SUITE 3A",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071157",
            "telephone_number": "321-768-1600",
            "fax_number": "321-799-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5070 MINTON RD NW",
            "address_2": "SUITE 5",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071157",
            "telephone_number": "321-768-1600",
            "fax_number": "321-768-6418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DERMATOLOGY ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-768-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME51282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Bay Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palm Bay Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cheri Ann Flanagan, PT
• Narica Fleming, RN
• Pansy Roselyn Fletcher
• Lisa Flint, MPT
• Diego Florentin Rodriguez, M.D.
• Florida Diagnostic Imaging Inc
• Florida Diagnostic Portable Imaging, Inc
• Florida Eye Associates Inc
• Florida Health Care of Brevard
• Florida Health Care Plan, Inc

• MOHS-Micrographic Surgery Physician in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• MOHS-Micrographic Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; 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.