Active NPI
Florida Dermatology Associates Inc
- MOHS-Micrographic Surgery Physician
- Palm Bay, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- MOHS-Micrographic Surgery Physician
- License
- ME51282
- Legal business name
- FLORIDA DERMATOLOGY ASSOCIATES INC
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ruben Moreno, MD
- Title
- President
- Phone
- (321) 768-1600
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| MOHS-Micrographic Surgery Physician | 207ND0101X | ME51282 | FL | Primary |
Addresses
Primary practice location
5070 Minton Rd NW
Suite 5
Palm Bay, FL 32907-1157
Mailing address
5070 Minton Rd NW
Suite 3a
Palm Bay, FL 32907-1157
Phone (321) 768-1600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070002166A | Other | FL | RAILROAD MEDICARE |
| 94928 | Other | FL | BCBS |
| 169940 | Other | FL | WELLCARE |
Other names 1
- Palm Bay Dermatology
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031223000239 | FL | Part B Supplier - Clinic/Group Practice | 1557269982 |
Receives reassigned benefits from 17 practitioners Practice locations: Cocoa, FL; Titusville, FL; Rockledge, FL; Palm Bay, FL; Melbourne, FL; Cocoa Beach, FL |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0938368 | Palm Bay Dermatology | Compliance | Apr 1, 2028 |
National Provider Directory
National Provider DirectoryLocations
4260 N US Highway 1
Cocoa, FL 32927
Phone (321) 768-1600
80 Woodland Ave
Cocoa Beach, FL 32931
Phone (321) 768-1600
5070 Minton Rd NW
Ste 2
Palm Bay, FL 32907
5070 Minton Rd NW
#3A
Palm Bay, FL 32907
5070 Minton Rd NW
Ste 5
Palm Bay, FL 32907
Phone (321) 768-1600
5070 Minton Rd NW
Ste 3A
Palm Bay, FL 32907
5070 Minton Rd NW
#8770
Palm Bay, FL 32907
Phone (321) 768-1600
5070 Minton Rd NW
Ste 3
Palm Bay, FL 32907
Phone (321) 768-1600
5201 Babcock St NE
Ste 3
Palm Bay, FL 32905
Phone (321) 768-1600
1978 US Highway 1
Rockledge, FL 32955
Phone (321) 802-1046
500 N Washington Ave
Ste 109
Titusville, FL 32796
Phone (321) 768-1600
Practitioners & affiliated clinicians
Practitioners 20
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- MOHS-Micrographic Surgery Physician
- Palm Bay, FL
- NPI 1225092331
FL, Mohs-Micrographic Surgery
-
- Clinical Pathology/Laboratory Medicine Physician
- Gainesville, FL
- NPI 1073682514
FL
NPI Registry JSON
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": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "070002166A",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "94928",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "169940",
"state": "FL"
}
],
"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"
}
]
}Other providers in Palm Bay, FL
Sources for this page
- 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.