Innovative Dermatology and Mohs Surgery LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME96589 Issued in FL

Legal business name

INNOVATIVE DERMATOLOGY AND MOHS SURGERY LLC

Practice address

3507 Lee Blvd
Ste 107
Lehigh Acres, FL 33971-1318

Phone

(239) 368-8071

Fax

(239) 368-8074

NPI assigned

Apr 3, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Andrew P Kontos, M.D.NPI 1427164466

Title

Owner

Phone

(239) 368-8071

Specialties & licenses 1

Addresses

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

Practitioners 4

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

• Andrew Peter Kontos, M.D.

  • MOHS-Micrographic Surgery Physician
  • Lehigh Acres, FL
  • NPI 1427164466
  Medicare reassignment Care Compare group Authorized official
• Harleigh Plachetka

  • Medical Physician Assistant
  • Lehigh Acres, FL
  • NPI 1669208773
  Medicare reassignment Care Compare group NPD
• Jenna Hicks, PA-C

  • Physician Assistant
  • Lehigh Acres, FL
  • NPI 1942990957
  Medicare reassignment Care Compare group
• Vanessa Jill Levine, NP

  • Nurse Practitioner
  • Cape Coral, FL
  • NPI 1114483906
  Medicare reassignment

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1487049722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3507 LEE BLVD",
            "address_2": "STE 107",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711318",
            "telephone_number": "239-368-8071",
            "fax_number": "239-368-8074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3507 LEE BLVD",
            "address_2": "STE 107",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711318",
            "telephone_number": "239-368-8071",
            "fax_number": "239-368-8074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DERMATOLOGY AND MOHS SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-03",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "KONTOS",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-368-8071",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME96589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Lehigh Acres, FL
• Providers in Lehigh Acres, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; 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.