Individual provider Active NPI

Kellie Ann Mosley-Mendez, D.O.

  • Dermatology Physician
  • Palm Beach Gardens, FL
National Provider Identifier
1386694388
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
OS 7914 Issued in FL
Practice address
600 Village Square Xing
Palm Beach Gardens, FL 33410-4543
Phone
(561) 693-0540
NPI assigned
May 11, 2006
Last updated
Jan 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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 OS 7914 FL Primary

Addresses

Primary practice location

600 Village Square Xing
Palm Beach Gardens, FL 33410-4543

Mailing address

600 Village Square Xing
Palm Beach Gardens, FL 33410-4543
Phone (561) 693-0540

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmosleymendez@directaddress.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20060217000427 FL Practitioner - Dermatology 4587679121 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Florida, PAGroup PAC ID 1153390414, 184 clinicians

Practice addresses (Care Compare)

261 9TH St S
Naples, FL 34102-6258
Phone (239) 216-4337

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions398
Removal or shaving of skin growth1-10
Skin biopsy155

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS 7914FLMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Water's Edge Dermatology, LLC Dermatology CurrentSince Feb 1, 2015 Accepting new patients
Aqua Dermatology of Florida, PA Dermatology CurrentSince Jan 1, 2022 Accepting new patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince Jan 1, 2022 Accepting new patients
Water's Edge Dermatology, LLC CurrentSince Feb 1, 2015 Accepting new patients
RSB Dermatology Inc Dermatology PastSince Apr 12, 2015 Accepting new patients

Locations

5101 Okeechobee Rd
Fort Pierce, FL 34947
Phone (772) 595-5995

6250 Lantana Rd
Ste 9
Lake Worth, FL 33463
Phone (561) 578-8100

2020 NE 36th St
Lighthouse Point, FL 33064
Phone (954) 960-8880

3973 N Federal Hwy
Lighthouse Point, FL 33064
Phone (954) 361-7862

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

261 9th St S
Naples, FL 34102
Phone (239) 216-4337

14840 Tamiami Trl
North Port, FL 34287
Phone (941) 564-1542

301 NE 19th Dr
Okeechobee, FL 34972
Phone (863) 357-0039

2845 Pga Blvd
Palm Beach Gardens, FL 33410
Phone (561) 693-0540

600 Village Square Xing
Palm Beach Gardens, FL 33410
Phone (561) 693-0540

2426 S Tamiami Trl
Sarasota, FL 34239
Phone (507) 398-2753

264 NW Peacock Blvd
Ste 201
St Lucie West, FL 34986
Phone (772) 323-2321

38162 Medical Center Ave
Zephyrhills, FL 33540
Phone (813) 782-2165

Networks

  • Freedom Health HMO Network

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1386694388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 VILLAGE SQUARE XING",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104543",
            "telephone_number": "561-693-0540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 VILLAGE SQUARE XING",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104543",
            "telephone_number": "561-693-0540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSLEY-MENDEZ",
        "first_name": "KELLIE ANN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS 7914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmosleymendez@directaddress.net",
            "affiliation": "N",
            "address_1": "600 Village Square Xing",
            "city": "Palm Beach Gardens",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334104543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palm Beach Gardens, FL

Sources for this page

Verify at the official NPI Registry.