NPIMap

Organization Active NPI

Luminary Dermatology of Miami, LLC

  • MOHS-Micrographic Surgery Physician
  • Miami, FL
National Provider Identifier
1114769767
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
LUMINARY DERMATOLOGY OF MIAMI, LLC
Practice address
8740 N Kendall Dr Ste 101
Miami, FL 33176-2209
Phone
(305) 661-8978
Fax
(941) 296-8501
NPI assigned
Jun 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Jessica Phillips
Title
Ceo
Phone
(941) 926-6553

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X Primary

Addresses

Primary practice location

8740 N Kendall Dr Ste 101
Miami, FL 33176-2209

Mailing address

4411 Bee Ridge Rd # 309
Sarasota, FL 34233-2514
Phone (941) 926-6553

Other practice location 1

925 NE 30th Ter Ste 308
Homestead, FL 33033-7614
Phone (786) 670-9799

Other names 1

  • Luminary Dermatology, PA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250131001444 FL Part B Supplier - Clinic/Group Practice 8527597814 Receives reassigned benefits from 13 practitioners
Practice locations: Homestead, FL; Miami, FL; North Miami Beach, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1114769767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 BEE RIDGE RD # 309",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342332514",
            "telephone_number": "941-926-6553",
            "fax_number": "941-296-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8740 N KENDALL DR STE 101",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331762209",
            "telephone_number": "305-661-8978",
            "fax_number": "941-296-8501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "925 NE 30th Ter Ste 308",
            "address_purpose": "LOCATION",
            "city": "Homestead",
            "state": "FL",
            "postal_code": "330337614",
            "country_code": "US",
            "telephone_number": "786-670-9799",
            "fax_number": "941-296-8501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LUMINARY DERMATOLOGY OF MIAMI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "941-926-6553"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Luminary Dermatology, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.

Verify at the official NPI Registry.