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 Physician 207N00000X OS5365 FL Primary
MOHS-Micrographic Surgery Physician 207ND0101X OS5365 FL
Dermatopathology Physician 207ND0900X OS5365 FL
Pediatric Dermatology Physician 207NP0225X OS5365 FL
Procedural Dermatology Physician 207NS0135X OS5365 FL
Family Medicine Physician 207Q00000X OS5365 FL
Allergy & Immunology (Internal Medicine) Physician 207RA0201X OS5365 FL
Plastic Surgery Physician 208200000X OS5365 FL
Surgery Physician 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 identifiers 1

IdentifierTypeStateIssuer
256877200MedicaidFL

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 Med Aso of FL Inc23 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 80)

220 N Westmonte Dr
Ste A
Altamonte Springs, FL 32714
Phone (407) 788-8900

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

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

2454 N McMullen Booth Rd
Ste 502
Clearwater, FL 33759
Phone (727) 265-8770

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

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

818 N Woodland Blvd
Deland, FL 32720
Phone (386) 738-8000

6274 Linton Blvd
Ste 201
Delray Beach, FL 33484

5721 NE 27th Ave
Ft Lauderdale, FL 33308
Phone (954) 772-0416

1435 W 49th Pl
Ste 702
Hialeah, FL 33012
Phone (305) 821-4464

3449 Johnson St
Hollywood, FL 33021
Phone (954) 338-8255

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

1551 Riverside Ave
Jacksonville, FL 32204

2255 Dunn Ave
Jacksonville, FL 32218
Phone (904) 292-0322

2255 Dunn Ave
Ste 100
Jacksonville, FL 32218
Phone (904) 292-0322

4100 Southpoint Dr E
Ste 701
Jacksonville, FL 32216

7855 Argyle Forest Blvd
Ste 70
Jacksonville, FL 32244

7855 Argyle Forest Blvd
Ste 701
Jacksonville, FL 32244
Phone (904) 483-2277

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": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS5365",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "OS5365",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256877200",
            "state": "FL"
        }
    ],
    "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.