Water's Edge Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

WATER'S EDGE DERMATOLOGY, LLC

Practice address

600 Village Square Crossing
Palm Beach Gardens, FL 33410

Phone

(561) 694-9493

Fax

(561) 694-9064

NPI assigned

Jul 19, 2006

Last updated

Dec 11, 2015By 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

Susan Davis

Title

Dir. Billing Ops

Phone

(561) 693-0540

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Water's Edge Dermatology, INC Former legal business name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Networks

• HealthSun Health Plans Network

Practitioners 83

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.

• Danica Alexander, D.O.

  • Dermatology Physician
  • Orlando, FL
  • NPI 1508088980
  Medicare reassignment NPD
• Katherine Smyth Atwood, PA-C

  • Medical Physician Assistant
  • Sebastian, FL
  • NPI 1376900084

  Dermatology

  Medicare reassignment NPD
• Sharon Gwyn Barrineau, ARNP

  • Nurse Practitioner
  • Okeechobee, FL
  • NPI 1407027873
  Medicare reassignment NPD
• Ryan Beadle, P.A.

  • Physician Assistant
  • Venice, FL
  • NPI 1073525655
  Medicare reassignment NPD
• Gioconda Alicia Boaz, PA-C

  • Physician Assistant
  • West Palm Beach, FL
  • NPI 1811238272
  Medicare reassignment NPD
• Shireen Bower, MSN, FNP-BC, NP-C

  • Family Nurse Practitioner
  • Boca Raton, FL
  • NPI 1477097442
  Medicare reassignment NPD
• Kelli Danielle Bryant, M.D.

  • Dermatology Physician
  • Wellington, FL
  • NPI 1881127108
  Medicare reassignment NPD
• Ronald G. Bush, M.D.

  • Surgery Physician
  • Palm Beach Gardens, FL
  • NPI 1578565461
  Medicare reassignment NPD
• Christopher Robin Cromwell, MD

  • Plastic and Reconstructive Surgery Physician
  • Port Saint Lucie, FL
  • NPI 1629073382
  Medicare reassignment NPD
• Bobbi Jo Darr

  • Family Nurse Practitioner
  • Orange City, FL
  • NPI 1659756377
  Medicare reassignment NPD
• Laura Destefano, DO

  • Dermatology Physician
  • Cape Coral, FL
  • NPI 1003145087
  Medicare reassignment NPD
• Darron D Digiulio, D.O.

  • Dermatology Physician
  • Plantation, FL
  • NPI 1144281395
  Medicare reassignment NPD

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449792000000",
    "number": "1134148992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 VILLAGE SQUARE CROSSING",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "33410",
            "telephone_number": "561-693-0540",
            "fax_number": "561-296-6174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 VILLAGE SQUARE CROSSING",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "33410",
            "telephone_number": "561-694-9493",
            "fax_number": "561-694-9064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATER'S EDGE DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-12-11",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIR. BILLING OPS",
        "authorized_official_telephone_number": "561-693-0540"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "38243",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Water's Edge Dermatology, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Tiffany Washington, APRN, PMHNP-BC, FNP
• Carly Washor, LCSW, MCAP, ICADC
• Lyam Cristina Wasko, LMT
• Alex Wasserman, DC
• Karen Estelle Wasserman, LCSW
• Water's Edge Dermatology, LLC
• Jack Waterman, D.O.
• Waterway Wellness & Psychiatry, LLC
• Miriam R Watkins, DC
• Grace Watson, RN

• Dermatology Physician in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; 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.