Individual provider Active NPI

Nathan Allen Bibliowicz, DO

  • Dermatology Physician
  • Clermont, FL
National Provider Identifier
1447593686
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
OS13968 Issued in FL
Practice address
1920 Don Wickham Dr Ste 330
Clermont, FL 34711-1978
Phone
(352) 241-4298
NPI assigned
Apr 5, 2013
Last updated
May 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X OS13968 FL Primary
Internal Medicine Physician 207R00000X 125.063879 IL

Addresses

Primary practice location

1920 Don Wickham Dr Ste 330
Clermont, FL 34711-1978

Mailing address

3520 N Westmoreland Dr
Orlando, FL 32804-3544
Phone (407) 312-0768

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
I20161107000136 FL Practitioner - DermatologyPractitioner - Internal Medicine 3375844848 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Lake Erie College of Osteopathic Medicine, Erie, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1920 Don Wickham Dr
Suite 330
Clermont, FL 34711-1978
Phone (352) 241-4298

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision267
Removal of skin lesions3931
Removal of nail tissue1-10
Removal or shaving of skin growth104
Skin biopsy663

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS13968FLMDDermatology Physician
125.063879ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Leavitt Medical Associates of Florida Inc Dermatology CurrentSince Jul 1, 2020 Accepting new patients
Leavitt Medical Associates of Florida Inc Dermatology CurrentSince Jul 1, 2020 Accepting new patients

Locations

1920 Don Wickham Dr
Ste 330
Clermont, FL 34711
Phone (352) 241-4298

151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293

1918 SE 17th St
#300
Ocala, FL 34471
Phone (352) 620-2420

1410 W Broadway St
Ste 205
Oviedo, FL 32765
Phone (407) 359-2100

1503 Buenos Aires Blvd
The Villages, FL 32159
Phone (352) 350-6244

1503 Buenos Aires Blvd
Ste 100
The Villages, FL 32159
Phone (352) 753-2812

340 Heald Way
Ste 238
The Villages, FL 32163
Phone (352) 571-7000

1801 Lee Rd
Ste 115
Winter Park, FL 32789
Phone (407) 644-1500

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 2

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": "1365120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1447593686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 N WESTMORELAND DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328043544",
            "telephone_number": "407-312-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 DON WICKHAM DR STE 330",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111978",
            "telephone_number": "352-241-4298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIBLIOWICZ",
        "first_name": "NATHAN",
        "middle_name": "ALLEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-05",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS13968",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.063879",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.