Palm Harbor Dermatology PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PALM HARBOR DERMATOLOGY PA

Practice address

4197 Woodlands Pkwy
Palm Harbor, FL 34685-3493

Phone

(727) 786-3810

Fax

(727) 786-3855

NPI assigned

Mar 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Amy Simon Ross, MDNPI 1659564193

Title

Ceo

Phone

(813) 333-1512

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• PHDermatology Doing business as

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 39

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

• Amy Simon Ross, MD

  • MOHS-Micrographic Surgery Physician
  • Tampa, FL
  • NPI 1659564193

  Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Divya Joseph Aickara, MD

  • MOHS-Micrographic Surgery Physician
  • Tampa, FL
  • NPI 1154940690
  Medicare reassignment Care Compare group NPD
• Olena Andikyan, APRN

  • Nurse Practitioner
  • Tampa, FL
  • NPI 1205547999
  Medicare reassignment Care Compare group NPD
• Elizabeth Aziz, DO

  • Dermatology Physician
  • Brandon, FL
  • NPI 1801424098
  Medicare reassignment Care Compare group NPD
• Julie Corinne Bucciarelli, APRN

  • Family Nurse Practitioner
  • Tampa, FL
  • NPI 1578059606
  Medicare reassignment Care Compare group NPD
• Steven Mark Burnett, MD

  • Dermatology Physician
  • Sarasota, FL
  • NPI 1063590149
  Medicare reassignment Care Compare group NPD
• Olivia Chukwuma, MD

  • Dermatology Physician
  • Dunedin, FL
  • NPI 1922685791
  Medicare reassignment Care Compare group NPD
• Melissa A Hodges, APRN

  • Nurse Practitioner
  • Brandon, FL
  • NPI 1942824594
  Medicare reassignment Care Compare group NPD
• Timothy F Kelly, M.D.

  • Dermatology Physician
  • Safety Harbor, FL
  • NPI 1184606816
  Medicare reassignment Care Compare group NPD
• Christopher R Kieliszak, D.O.

  • Facial Plastic Surgery Physician
  • Tampa, FL
  • NPI 1346508421
  Medicare reassignment Care Compare group NPD
• Connie Jane Lago, MD

  • Dermatology Physician
  • Riverview, FL
  • NPI 1932736865
  Medicare reassignment Care Compare group NPD
• Scott Forrester Lindsey, M.D.

  • MOHS-Micrographic Surgery Physician
  • Tampa, FL
  • NPI 1013317460

  Dermatology

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1497927016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4197 WOODLANDS PKWY",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346853493",
            "telephone_number": "813-333-1512",
            "fax_number": "813-333-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4197 WOODLANDS PKWY",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346853493",
            "telephone_number": "727-786-3810",
            "fax_number": "727-786-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM HARBOR DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "SIMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-333-1512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "000WR",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHDermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Palm Harbor Chiropractic and Rehabilitation Clinic, Inc.
• Palm Harbor Christian Counseling Center of Timothy N. Daley, PHD PA
• Palm Harbor Counseling Team
• Palm Harbor Dental Associates Inc
• Palm Harbor Dental Group
• Palm Harbor Family Counseling Center
• Palm Harbor Family Counseling Center Inc.
• Palm Harbor Family Dentistry
• Palm Harbor FL Opco LLC
• Palm Harbor Internal Medicine and Pediatrics, PA

• Dermatology Physician in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; 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.