NPIMap

Organization Active NPI

Selectskinmd LLC

  • MOHS-Micrographic Surgery Physician
  • Vero Beach, FL
National Provider Identifier
1427414168
Registry record updated Mar 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
ME101443 Issued in FL
Legal business name
SELECTSKINMD LLC
Practice address
1325 36TH St
Suite a
Vero Beach, FL 32960-6599
Phone
(772) 567-1164
NPI assigned
Jan 11, 2016
Last updated
Mar 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2016

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

Authorized official

Name
Monika Srivastava, MDNPI 1437117058
Title
Owner
Phone
(772) 567-1164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X ME101443 FL Primary

Addresses

Primary practice location

1325 36TH St
Suite a
Vero Beach, FL 32960-6599

Mailing address

1325 36TH St
Suite a
Vero Beach, FL 32960-6599
Phone (772) 567-1164

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160215002271 FL Part B Supplier - Clinic/Group Practice 7517261365 Receives reassigned benefits from 9 practitioners
Practice locations: Vero Beach, FL

National Provider Directory

National Provider Directory

Locations

1600 36th St
Ste B
Vero Beach, FL 32960
Phone (772) 567-1164

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1427414168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 36TH ST",
            "address_2": "SUITE A",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329606599",
            "telephone_number": "772-567-1164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 36TH ST",
            "address_2": "SUITE A",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329606599",
            "telephone_number": "772-567-1164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECTSKINMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "SRIVASTAVA",
        "authorized_official_first_name": "MONIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-567-1164",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME101443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.