Myers & Fotopoulos MDS PA

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

MYERS & FOTOPOULOS MDS PA

Doing business as

New Image Dermatology

Practice address

5534 Gulf Dr
Ste 1
New Port Richey, FL 34652-4000

Phone

(727) 847-3992

Fax

(727) 848-1118

NPI assigned

Oct 14, 2005

Last updated

Jan 30, 2014By 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

Dr. Theodore Fotopoulos, M.D.NPI 1598765760

Title

President

Phone

(727) 847-3992

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• NEW IMAGE DERMATOLOGY 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 3

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.

• Theodore N Fotopoulos, MD

  • MOHS-Micrographic Surgery Physician
  • New Port Richey, FL
  • NPI 1598765760
  Medicare reassignment Care Compare group NPD Authorized official
• Ereni A Fotopoulos, PA-C

  • Physician Assistant
  • New Port Richey, FL
  • NPI 1245824739
  Medicare reassignment Care Compare group
• Ryan Koehn, PA-C

  • Physician Assistant
  • New Port Richey, FL
  • NPI 1114270675
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1275522054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5534 GULF DR",
            "address_2": "STE 1",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346524000",
            "telephone_number": "727-847-3992",
            "fax_number": "727-848-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5534 GULF DR",
            "address_2": "STE 1",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346524000",
            "telephone_number": "727-847-3992",
            "fax_number": "727-848-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYERS & FOTOPOULOS MDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "FOTOPOULOS",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-847-3992",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8550571-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "34711",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5751",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEW IMAGE DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• MOHS-Micrographic Surgery Physician in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• MOHS-Micrographic Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; 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.