Stacy R Rosenblum, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

006121 Issued in AZ

Practice address

3319 State Road 7
Ste 110
Wellington, FL 33449-8094

Phone

(561) 784-7884

Fax

(561) 784-7884

NPI assigned

Jul 26, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Philadelphia College of Osteopathic Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitalmd Group Holding LLCGroup PAC ID 8921091786, 535 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vitalmd Group Holding LLC

  • Obstetrics & Gynecology Physician
  • Miami, FL
  • NPI 1871572032

  Dermatology

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1374796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1609218965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844492",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900844492",
            "telephone_number": "480-948-8400",
            "fax_number": "480-948-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3319 STATE ROAD 7",
            "address_2": "STE 110",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334498094",
            "telephone_number": "561-784-7884",
            "fax_number": "561-784-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBLUM",
        "first_name": "STACY",
        "middle_name": "R",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-26",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "006121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "835513",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Veronica D Romero, APRN
• Ronin Services LLC
• Kelsea Danielle Rosales
• Wendy Herrera Rosario, OTD, OTR/L
• Jill Lisa Rosen, LCSW
• Jessica Rosner
• Mark D Rothenberg, MD
• Taras Roud, DMD
• Aaron Haim Rousso
• Diana Rousso, LMHC

• Dermatology Physician in Wellington, FL
• Providers in Wellington, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.