Clearly Derm, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME42065 Issued in FL

Legal business name

CLEARLY DERM, LLC

Practice address

1760 N Congress Ave
Suite 200
Boynton Beach, FL 33426-8214

Phone

(561) 739-9595

Fax

(561) 739-7546

NPI assigned

May 17, 2011

Organization subpart

No

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

Authorized official

Name

Andrea Colton, MDNPI 1821107061

Title

Medical Director

Phone

(561) 299-3907

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Networks

• HealthSun Health Plans Network

Interoperability endpoints

• FHIR API: https://clearly.mmi.prod.fhir.ema-api.com/fhir/r4/

Practitioners 34

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

• Andrea Colton, MD

  • Dermatology Physician
  • Delray Beach, FL
  • NPI 1821107061
  Medicare reassignment NPD Authorized official
• Lisa Ann Antonczak, APRN

  • Nurse Practitioner
  • Boynton Beach, FL
  • NPI 1801363411
  Medicare reassignment NPD
• Amanda Bienenfeld, MD

  • Dermatology Physician
  • Boca Raton, FL
  • NPI 1508355447
  Medicare reassignment NPD
• Thomas H. Cahn, M.D.

  • Dermatology Physician
  • Jupiter, FL
  • NPI 1306828843
  Medicare reassignment NPD
• Sasha Chediak, D.O.

  • Dermatology Physician
  • Fort Lauderdale, FL
  • NPI 1497142517
  Medicare reassignment NPD
• Nicole Conrad, MD

  • Dermatology Physician
  • Coral Springs, FL
  • NPI 1679565881
  Medicare reassignment NPD
• Julia Escandon Brehm, MD, PHD

  • Dermatology Physician
  • Boca Raton, FL
  • NPI 1952861627
  Medicare reassignment NPD
• Dana Jean Glass, ARNP

  • Nurse Practitioner
  • Jupiter, FL
  • NPI 1083268940
  Medicare reassignment NPD
• Meredith Hancock, MD

  • Dermatology Physician
  • Delray Beach, FL
  • NPI 1275899510

  Single Specialty

  Medicare reassignment NPD
• Dan Ilkovitch, MD, PHD

  • Dermatology Physician
  • Aventura, FL
  • NPI 1447512827
  Medicare reassignment NPD
• Stephanie N. Lasky, DO

  • Dermatology Physician
  • Hollywood, FL
  • NPI 1740544956
  Medicare reassignment NPD
• Elizabeth J Meador, ARNP

  • Nurse Practitioner
  • Delray Beach, FL
  • NPI 1619067055
  Medicare reassignment NPD

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1487947008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7050 W PALMETTO PARK RD",
            "address_2": "SUITE 30",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334333426",
            "telephone_number": "561-353-3376",
            "fax_number": "561-404-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 N CONGRESS AVE",
            "address_2": "SUITE 200",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334268214",
            "telephone_number": "561-739-9595",
            "fax_number": "561-739-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARLY DERM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "COLTON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "561-299-3907",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME42065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCC",
            "identifier": "10453",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STAE LICENSE",
            "identifier": "HCC9614",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "HCC9613",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.