Porter Premier Dermatology and Surgery Center, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME96233 Issued in FL

Legal business name

PORTER PREMIER DERMATOLOGY AND SURGERY CENTER, PLLC

Practice address

1515 W Nasa Blvd Ste 101
Melbourne, FL 32901-2605

Phone

(321) 308-0659

Fax

(321) 309-2881

NPI assigned

Oct 22, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Anthony Jerome Porter, M.D.NPI 1013957133

Title

Owner

Phone

(321) 308-0659

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 4

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

• Anthony Jerome Porter, MD

  • Dermatology Physician
  • Melbourne, FL
  • NPI 1013957133
  Medicare reassignment Care Compare group NPD Authorized official
• Stephanie Nowak, APRN

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1700361094
  Medicare reassignment Care Compare group NPD
• Christian Anthony Staniec, PA-C

  • Physician Assistant
  • Melbourne, FL
  • NPI 1003871849
  Medicare reassignment Care Compare group
• Judith A Paternoster, ARNP

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1780750877
  Medicare reassignment NPD

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1104152495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 W NASA BLVD STE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012605",
            "telephone_number": "321-308-0659",
            "fax_number": "321-309-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W NASA BLVD STE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012605",
            "telephone_number": "321-308-0659",
            "fax_number": "321-309-2881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1344 S Apollo Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329013183",
            "country_code": "US",
            "telephone_number": "321-308-0659",
            "fax_number": "321-309-2881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6032 Farcenda Pl Ste 102",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329407341",
            "country_code": "US",
            "telephone_number": "321-608-8160",
            "fax_number": "321-622-6818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PORTER PREMIER DERMATOLOGY AND SURGERY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-22",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-308-0659",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME96233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacia Poole, MD
• Darlene Go Popat, M.D.
• Jessica R Pope, SLP
• Karen S Popovich, OT, CHT
• Floro Porciuncula, MD
• Anthony Jerome Porter, MD
• Whitney Portillo, FNP
• Arielle Poteau
• John H Potomski Jr., DO CMA
• Wendy Potter, M.ED., LMHC

• Dermatology Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.