NPIMap

Organization Active NPI

Weinkle Dermatology, Inc.

  • Dermatology Physician
  • Bradenton, FL
National Provider Identifier
1154093839
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WEINKLE DERMATOLOGY, INC.
Practice address
5601 21St Ave W Ste B
Bradenton, FL 34209-5642
Phone
(941) 794-5432
Fax
(941) 794-5682
NPI assigned
Oct 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Susan Holloway Weinkle, MDNPI 1992897938
Title
President
Phone
(941) 794-5432

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)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

5601 21St Ave W Ste B
Bradenton, FL 34209-5642

Mailing address

5601 21St Ave W Ste B
Bradenton, FL 34209-5642
Phone (941) 794-5432

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211108001696 FL Part B Supplier - Clinic/Group Practice 1850780172 Receives reassigned benefits from 5 practitioners
Practice locations: Bradenton, FL

National Provider Directory

National Provider Directory

Locations

5601 21st Ave W
Ste B
Bradenton, FL 34209
Phone (941) 794-5432

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1154093839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 21ST AVE W STE B",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342095642",
            "telephone_number": "941-794-5432",
            "fax_number": "941-794-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 21ST AVE W STE B",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342095642",
            "telephone_number": "941-794-5432",
            "fax_number": "941-794-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEINKLE DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "WEINKLE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "HOLLOWAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-794-5432",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.