Active NPI
Sidney Possick, M.D.
- Dermatology Physician
- Daytona Beach, FL
National Provider Identifier
1275639114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 19498
- Practice address
- 655 N Clyde Morris Blvd
Suite B
Daytona Beach, FL 32114-2321 - Phone
- (386) 252-5578
- Fax
- (386) 257-3660
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 19498 | FL | Primary |
Addresses
Primary practice location
655 N Clyde Morris Blvd
Suite B
Daytona Beach, FL 32114-2321
Mailing address
655 N Clyde Morris Blvd
Suite B
Daytona Beach, FL 32114-2321
Phone (386) 252-5578
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64266Z | Other | FL | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19498 | FL | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267142400000",
"number": "1275639114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 N CLYDE MORRIS BLVD",
"address_2": "SUITE B",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321142321",
"telephone_number": "386-252-5578",
"fax_number": "386-257-3660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 N CLYDE MORRIS BLVD",
"address_2": "SUITE B",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321142321",
"telephone_number": "386-252-5578",
"fax_number": "386-257-3660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POSSICK",
"first_name": "SIDNEY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2010-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "FL",
"license": "19498",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "64266Z",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.