NPIMap

Organization Active NPI

Leavitt Medical Associates of Florida Inc

Doing business as Advanced Dermatology And Cosmetic Surgery

  • Dermatology Physician
  • Heathrow, FL
National Provider Identifier
1528097284
Registry record updated Aug 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
OS5365 Issued in FL
Legal business name
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Doing business as
Advanced Dermatology And Cosmetic Surgery
Practice address
120 International Pkwy
240
Heathrow, FL 32746-5031
Phone
(407) 333-4200
Fax
(407) 829-6637
NPI assigned
Jul 2, 2006
Last updated
Aug 29, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2017

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

Authorized official

Name
Amy Declue
Title
Director of Provider Services
Phone
(407) 875-2080

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X OS5365 FL Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X OS5365 FL
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X OS5365 FL
Pediatric Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NP0225X OS5365 FL
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X OS5365 FL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X OS5365 FL
Allergy & Immunology (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0201X OS5365 FL
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X OS5365 FL
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X OS5365 FL

Addresses

Primary practice location

120 International Pkwy
240
Heathrow, FL 32746-5031

Mailing address

151 Southhall LN
Ste 300
Maitland, FL 32751-7233
Phone (407) 875-2080

Other names 1

  • Advanced Dermatology And Cosmetic Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050228000737 FL Part B Supplier - Clinic/Group Practice 4688579311 Receives reassigned benefits from 243 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0973519Advanced Dermatology & Cosmetic Surgery120 International Pkwy Ste 240, Heathrow, FL 32746AccreditationJun 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Leavitt Med23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations (25 of 64)

2620 S Seacrest Blvd
Boynton Beach, FL 33435
Phone (561) 737-4888

2620 S Seacrest Blvd
Ste A
Boynton Beach, FL 33435

2620 S Seacrest Blvd
Ste B
Boynton Beach, FL 33435
Phone (561) 737-4888

2902 59th St W
Ste A
Bradenton, FL 34209
Phone (941) 757-0763

540 Medical Oaks Ave
Brandon, FL 33511

710 Oakfield Dr
Ste 154
Brandon, FL 33511
Phone (813) 651-1991

14540 Cortez Blvd
Ste 115
Brooksville, FL 34613
Phone (352) 345-4807

632 Del Prado Blvd N
Cape Coral, FL 33909
Phone (239) 772-5577

26344 US Highway 19 N
Clearwater, FL 33761
Phone (727) 669-3676

3251 N McMullen Booth Rd
Ste 202
Clearwater, FL 33761
Phone (727) 712-3455

2757 Citrus Tower Blvd
Ste 201
Clermont, FL 34711

2893 Enterprise Rd
Debary, FL 32713

2893 Enterprise Rd
Ste 100
Debary, FL 32713
Phone 3867898600 ext. 38678

600 W Plymouth Ave
Deland, FL 32720
Phone (386) 738-0322

630 W Plymouth Ave
Deland, FL 32720
Phone (386) 734-3654

1300 NW 17th Ave
Ste 130
Delray Beach, FL 33445
Phone (561) 819-0857

6274 Linton Blvd
Ste 201
Delray Beach, FL 33484

12525 Philips Hwy
Ste 101
Jacksonville, FL 32256
Phone (904) 400-6565

14810 Old Saint Augustine Rd
Jacksonville, FL 32258
Phone (904) 512-1899

4100 Southpoint Dr E
Ste 701
Jacksonville, FL 32216

7855 Argyle Forest Blvd
Ste 70
Jacksonville, FL 32244

9191 R G Skinner Pkwy
#202203
Jacksonville, FL 32256

2101 S US Highway 1
Jupiter, FL 33477
Phone (561) 748-0510

120 International Pkwy
Ste 120
Lake Mary, FL 32746

120 International Pkwy
Ste 240
Lake Mary, FL 32746
Phone (407) 333-4200

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 196

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 196

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503964800000",
    "number": "1528097284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN",
            "address_2": "STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517233",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 INTERNATIONAL PKWY",
            "address_2": "240",
            "city": "HEATHROW",
            "state": "FL",
            "postal_code": "327465031",
            "telephone_number": "407-333-4200",
            "fax_number": "407-829-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2017-08-29",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER SERVICES",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS5365",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology And Cosmetic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Heathrow, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2017; 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.