Vital Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

VITAL DERMATOLOGY LLC

Practice address

6202 N 9TH Ave Ste 2
Pensacola, FL 32504-8291

Phone

(850) 888-2424

Fax

(620) 710-7703

NPI assigned

Nov 12, 2019

Organization subpart

No

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

Authorized official

Name

Jenna Beasley, MDNPI 1992063267

Title

Owner

Phone

(850) 888-2424

Specialties & licenses 1

Addresses

Other names 1

• Vital Dermatology Doing business as

Electronic endpoints 1

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

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00317

Practitioners 1

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

• Jenna Beasley, MD

  • Dermatology Physician
  • Pensacola, FL
  • NPI 1992063267
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588464000000",
    "number": "1386289585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6202 N 9TH AVE STE 2",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048291",
            "telephone_number": "850-888-2424",
            "fax_number": "620-710-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6202 N 9TH AVE STE 2",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048291",
            "telephone_number": "850-888-2424",
            "fax_number": "620-710-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2020-05-03",
        "certification_date": "2020-05-03",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-888-2424",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Fax",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Fax",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Fax",
            "address_1": "6202 N 9th Ave Ste 2",
            "city": "Pensacola",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325048291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Vital Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2020; 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.