Individual provider Active NPI

Mary Elizabeth Anderson, MD

  • Dermatology Physician
  • Jacksonville Beach, FL
National Provider Identifier
1265960264
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME155627 Issued in FL
Practice address
3200 3Rd St S Ste 200
Jacksonville Beach, FL 32250-6097
Phone
(813) 321-1786
Fax
(813) 321-1787
NPI assigned
Jun 2, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X ME155627 FL Primary

Addresses

Primary practice location

3200 3Rd St S Ste 200
Jacksonville Beach, FL 32250-6097

Mailing address

18228 N US Highway 41
Lutz, FL 33549-4400
Phone (813) 321-1786

Other identifiers 1

IdentifierTypeStateIssuer
124534000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210802002163 TX Practitioner - Dermatology 9638441447 Reassigns benefits to 1 organization
I20241111003929 FL Practitioner - Dermatology 9638441447 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Columbia University College of Physicians and Surgeons, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Skin SolutionsGroup PAC ID 7416018221, 102 clinicians

Practice addresses (Care Compare)

3200 3Rd St S
Suite 200
Jacksonville Beach, FL 32250-6097
Phone (813) 321-1786

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision14
Removal of skin lesions445
Skin biopsy189

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME155627FLMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oliver Street 5.01(a) Inc. Dermatology CurrentSince Sep 1, 2021 Accepting new patients
Suncoast Skin Solutions Dermatology CurrentSince Oct 1, 2025 Accepting new patients
Douglas K Pierce MD PA Past Accepting new patients
Skin and Cancer Associates Dermatology PastSince Jun 30, 2024 Accepting new patients

Locations

3200 3rd St S
Ste 200
Jax Bch, FL 32250
Phone (904) 249-6110

4651 Van Dyke Rd
Lutz, FL 33558

18228 N US Highway 41
Lutz, FL 33549

11200 Seminole Blvd
Ste 205
Seminole, FL 33778
Phone (727) 820-1786

4340 N Josey Ln
Ste 204
Carrollton, TX 75010
Phone (469) 800-4900

5310 Harvest Hill Rd
Ste 290
Dallas, TX 75230
Phone (214) 420-0672

6117 Berkshire Ln
Dallas, TX 75225
Phone (214) 373-3376

Interoperability endpoints

  • Direct secure messaging: manderson80991@direct.phhs.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758844800000",
    "number": "1265960264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18228 N US HIGHWAY 41",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335494400",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 3RD ST S STE 200",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322506097",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-02",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME155627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124534000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

Verify at the official NPI Registry.