Kelly Diane Tepedino, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME122956 Issued in FL

Practice address

1722 SW Newland Way
Lake City, FL 32025-6915

Phone

(386) 344-6102

Fax

(386) 344-6103

NPI assigned

May 29, 2012

Last updated

Mar 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

DermatologyAlso: Internal Medicine

Education

University of Florida College of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Florida Dermatology LLCGroup PAC ID 9830486166, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Florida Dermatology LLC

  • Dermatology Physician
  • Lake City, FL
  • NPI 1689023830
  Medicare reassignment Care Compare group NPD Authorized official
• Miguel J Tepedino MD PA

  dba North Florida Family Medicine

  • Family Medicine Physician
  • Lake City, FL
  • NPI 1275763427
  NPD

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1619237369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 SW NEWLAND WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256915",
            "telephone_number": "386-344-6102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 SW NEWLAND WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256915",
            "telephone_number": "386-344-6102",
            "fax_number": "386-344-6103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 SW Newland Way",
            "address_purpose": "LOCATION",
            "city": "Lake City",
            "state": "FL",
            "postal_code": "320256966",
            "country_code": "US",
            "telephone_number": "386-344-6102",
            "fax_number": "386-344-6103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEPEDINO",
        "first_name": "KELLY",
        "middle_name": "DIANE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-29",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME122956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donia C Taylor
• Sonia Yolanda Taylor, RN
• Taylors Passionate Care LLC
• Megan Tenney, ARNP
• Melinda C Tenorio, MD
• Miguel Jose Tepedino, MD
• David Charles Terrell Jr., ARNP
• Tymber Tatum Terrell, APRN
• Testsmarter Inc
• Testsmarter Inc (Sleep Solutions of North Florida)

• Dermatology Physician in Lake City, FL
• Providers in Lake City, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.