Anne Hardick Dacko, MD
Individual provider Active NPI Dermatology Physician · Breezy Point, NY
NPI 1487636858 · NPPES record last updated Jan 7, 2019
Key facts
- NPI
- 1487636858
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 220931 (NY)
- Practice address
- 20408 Rockaway Point Blvd
Breezy Point, NY 11697 - Phone
- (646) 421-6064
- NPI assigned
- Nov 18, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- State University of New York at Stony Brook, School of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Laca Dermatology Inc
Kathleen Vine MD PC
Practice addresses (Care Compare)
4955 Van Nuys Blvd
Suite 516
Sherman Oaks, CA 91403-1832
Phone (818) 789-6296
928 Broadway
Suite 301
New York, NY 10010-8156
Phone (646) 421-6064
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 26 |
| Removal of tissue | 1-10 |
| Removal of skin lesions | 633 |
| Removal of skin cancer | 161 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 95 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040518000097 | NY | Practitioner - Dermatology | 3274523550 | Reassigns benefits to 1 organization |
| I20171213000930 | CA | Practitioner - Dermatology | 3274523550 |
Reassigns benefits to 1 organization Practice locations: Sherman Oaks, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53733 | CA | MD | General Practice Dentistry |
| 220931 | NY | MD | Dermatology Physician |
| 33D2064399 | NY | MD | MOHS-Micrographic Surgery Physician |
Practice roles (13 of 17)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kathleen Vine MD PC | Dermatology | Current |
Accepting new patients |
| Anne Hardick Dacko, M.D., PLLC | Dermatology | Current |
Accepting new patients |
| Laca Dermatology, Inc | Mohs-Micrographic Surgery | Current |
Accepting new patients |
| Icahn School of Medicine at Mount Sinai | Dermatology | Past | Accepting new patients |
| The New York and Presbyterian Hospital | Past | Accepting new patients | |
| Beth Israel Medical Center | Past | Accepting new patients | |
| St Lukes-Roosevelt Hospital Center | Dermatology | Past | Accepting new patients |
| John F. Romano M.D. PLLC | Dermatology | Past | Accepting new patients |
| BB Medical and Dermatology Inc | Mohs-Micrographic Surgery | Past | Accepting new patients |
| Forest Hills Dermatology Group PLLC | Dermatology | Past |
Accepting new patients |
| Beth Israel Medical Center | Dermatology | Past | Accepting new patients |
| Dermatology Services of Kingston P.C. | Past |
Accepting new patients | |
| St Lukes Roosevelt Community Care | Dermatology | Past | Accepting new patients |
Locations
1920 Hillhurst Ave
Los Angeles, CA 90027
Phone (213) 279-5725
2526 Hyperion Ave
Ste 3A
Los Angeles, CA 90027
4955 Van Nuys Blvd
Ste 516
Sherman Oaks, CA 91403
Phone (818) 789-6296
928 Broadway
Ste 301
New York, NY 10010
Phone (646) 421-6064
166 5th Ave
Fl 2
New York, NY 10010
Phone (212) 229-0333
9 E 8th St
#255
New York, NY 10003
20408 Rockaway Point Blvd
Rockaway Point, NY 11697
Phone (646) 421-6064
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- anne.hardickdacko.p1@direct.lakeside.nextgenshare.com
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| MOHS-Micrographic Surgery Physician | 207ND0101X | 33D2064399 | NY | |
| Dermatology Physician | 207N00000X | 220931 | NY | Yes |
Addresses
Primary practice location
20408 Rockaway Point Blvd
Breezy Point, NY 11697
Mailing address
20408 Rockaway Point Blvd
Breezy Point, NY 11697-1115
Phone (646) 421-6064
Other practice location 1
24 E 12th St Ste 304
New York, NY 10003-4513
Phone (646) 421-6064
Other practice location 2
928 Broadway Ste 301
New York, NY 10010-8156
Phone (646) 421-6064
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02161379 | Medicaid | NY |
Other providers in Breezy Point, NY
- Patricia Carpenter
- Diane Carroll
- Jaclyn C Devlin
- Brianne Kathleen Fitzgerald
- Maryellen Gregory Hammill
- Megan Elizabeth Holihan
- Kaminer Dentistry PLLC
- Caroline Ann Kane
- Jonathan Elliott Lewis
- Life Quality P.T P.C
All providers in Breezy Point, NY · Dermatology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.