NPIMap

Organization Active NPI

Leavitt Medical Associates of Florida Inc

Doing business as Advanced Dermatology and Cosmetic Surgery

  • Dermatology Physician
  • Land O' Lakes, FL
National Provider Identifier
1447418959
Registry record updated May 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Doing business as
Advanced Dermatology and Cosmetic Surgery
Practice address
19455 Shumard Oak Dr
Ste 106
Land O Lakes, FL 34638-7257
Phone
(813) 868-5200
Fax
(813) 868-5220
NPI assigned
May 30, 2008
Last updated
May 10, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2017

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

Authorized official

Name
Amy Declue
Title
Director, Provider Services
Phone
(407) 875-2080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

19455 Shumard Oak Dr
Ste 106
Land O Lakes, FL 34638-7257

Mailing address

151 Southhall LN
Ste 300
Maitland, FL 32751-7176
Phone (407) 875-2080

Other names 1

  • Advanced Dermatology and Cosmetic Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050228000737 FL Part B Supplier - Clinic/Group Practice 4688579311 Receives reassigned benefits from 243 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Leavitt Med Aso of FL Inc23 organizations share this tax ID, including this one
Part of
Leavitt Med Aso of FL Inc

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

19455 Shumard Oak Dr
Unit 106
Land O Lakes, FL 34638
Phone (813) 868-5200

Practitioners & affiliated clinicians

Practitioners 7

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": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494374400000",
    "number": "1447418959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN",
            "address_2": "STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517176",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19455 SHUMARD OAK DR",
            "address_2": "STE 106",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346387257",
            "telephone_number": "813-868-5200",
            "fax_number": "813-868-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "enumeration_date": "2008-05-30",
        "last_updated": "2017-05-10",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER SERVICES",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Cosmetic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Land O' Lakes, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.