Nicky Gazy
Individual provider Active NPI Dermatology Physician · Pembroke Pines, FL
NPI 1104311075 · NPPES record last updated Aug 30, 2023
Key facts
- NPI
- 1104311075
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- OS19219 (FL)
- Practice address
- 3 SW 129TH Ave Ste 100
Pembroke Pines, FL 33027-1778 - Phone
- (866) 400-3376
- NPI assigned
- Jun 24, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Florida Dermatology Group, Inc.
Leavitt Medical Associates of Florida Inc
Practice addresses (Care Compare)
12600 SW 120TH St
Suite 113
Miami, FL 33186-9116
Phone (305) 971-1210
3006 17TH St
Saint Cloud, FL 34769-6011
Phone (407) 498-7100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 13 |
| Removal of skin lesions | 139 |
| Removal of skin cancer | 67 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 81 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL, MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220909001332 | FL | Practitioner - Dermatology | 0648655746 | Reassigns benefits to 2 organizations |
| I20221205001928 | MI | Practitioner - Dermatology | 0648655746 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS19219 | FL | MD | Dermatology Physician |
| 5101024255 | MI | MD | Dermatology Physician |
| 5151011340 | MI | MD | Dermatology Physician |
Practice roles (4 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Florida Dermatology Group, Inc. | Dermatology | Current |
Accepting new patients |
| Advanced Dermatology of Michigan PC | Dermatology | Current |
Accepting new patients |
| Leavitt Medical Associates of Florida Inc | Dermatology | Current |
Accepting new patients |
| Leavitt Medical Associates of Florida Inc | Dermatology | Current |
Accepting new patients |
Locations
1905 Clint Moore Rd
Ste 103
Boca Raton, FL 33496
Phone (561) 241-4474
401 Coral Way
Ste 207
Coral Gables, FL 33134
Phone (305) 445-2941
2915 Lakeview Dr
Ste 2021
Fern Park, FL 32730
Phone (407) 788-8900
82245 Overseas Hwy
Islamorada, FL 33036
Phone (305) 664-0700
151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293
12600 SW 120th St
Ste 113
Miami, FL 33186
Phone (305) 971-1210
21097 NE 27th Ct
Ste 500
Miami, FL 33180
Phone (305) 931-6661
1410 W Broadway St
Ste 205
Oviedo, FL 32765
Phone (407) 359-2100
3 SW 129th Ave
Ste 100
Pembroke Pines, FL 33027
Phone (954) 447-3200
3006 17th St
Saint Cloud, FL 34769
Phone (407) 498-7100
1503 Buenos Aires Blvd
Ste 100
The Villages, FL 32159
Phone (352) 753-2812
2229 N Commerce Pkwy
Ste 210
Weston, FL 33326
Phone (954) 709-2701
416 S Creyts Rd
Lansing, MI 48917
Phone (517) 327-0966
4170 Cedar Bluff Dr
Petoskey, MI 49770
13450 E 12 Mile Rd
Warren, MI 48088
Phone (586) 759-5525
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 5101024255 | MI | |
| Dermatology Physician | 207N00000X | 5151011340 | MI | |
| Dermatology Physician | 207N00000X | OS19219 | FL | Yes |
Addresses
Primary practice location
3 SW 129TH Ave Ste 100
Pembroke Pines, FL 33027-1778
Mailing address
21097 NE 27TH CT Ste 500
Aventura, FL 33180-1235
Phone (305) 931-6661
Other practice location 1
5450 Fort St
Trenton, MI 48183-4601
Phone (734) 671-3800
Other providers in Pembroke Pines, FL
- Francis Gaton
- Kandice Nicole Gauthier
- Cynthia E Gavilanes
- Asia Rose Gaylord
- Arturo Jose Gazo
- Martha Berhane Gebru
- Milton Gedallovich
- Priya Ginu Geevarghese
- Bruce M Gelch
- Herschel A Gelfand
All providers in Pembroke Pines, FL · Dermatology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.