Elite Dermatology and Aesthetic Institute, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS1629 Issued in FL

Legal business name

ELITE DERMATOLOGY AND AESTHETIC INSTITUTE, LLC

Practice address

1905 Clint Moore Rd
Suite 203
Boca Raton, FL 33496-2658

Phone

(561) 826-6650

Fax

(561) 826-6649

NPI assigned

Jun 20, 2014

Organization subpart

No

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

Authorized official

Name

Fawn Winkelman, DONPI 1700192796

Title

President

Phone

(561) 826-6650

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ELITE MEDICINE AND AESTHETIC INSTITUTE Doing business as

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 1

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

• Fawn Winkelman, DO

  • General Practice Physician
  • Boca Raton, FL
  • NPI 1700192796
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1154735819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 CLINT MOORE RD",
            "address_2": "SUITE 203",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334962658",
            "telephone_number": "561-826-6650",
            "fax_number": "561-826-6649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 CLINT MOORE RD",
            "address_2": "SUITE 203",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334962658",
            "telephone_number": "561-826-6650",
            "fax_number": "561-826-6649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DERMATOLOGY AND AESTHETIC INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-20",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "WINKELMAN",
        "authorized_official_first_name": "FAWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-826-6650",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS1629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "11877A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELITE MEDICINE AND AESTHETIC INSTITUTE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ludger Girardo Eliacin, M.D.
• Jennyflore Eliazar, PHARMD
• Jean-Philippe Elie, MD
• Aviv Elimelech
• Elina Agency, Inc
• Elite Diabetes and Endocrine Specialists LLC
• Elite Fracture Care PLLC
• Elite Home Health Group LLC
• Elite Home Health of the Palm Beaches, LLC
• Elite MD, Inc.

• Family Medicine Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; 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.