Advanced Dermatologic & Cosmetic Institute Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME95851

Legal business name

ADVANCED DERMATOLOGIC & COSMETIC INSTITUTE INC

Practice address

90 Cypress Way E
Suite 50
Naples, FL 34110-9275

Phone

(239) 598-3200

Fax

(239) 598-0233

NPI assigned

May 26, 2006

Organization subpart

No

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

Authorized official

Name

Srdjan Prodanovich, MDNPI 1871540377

Title

Owner

Phone

(239) 598-3200

Specialties & licenses 1

Addresses

Other identifiers 1

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 2

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

• Srdjan Prodanovich, MD

  • Dermatology Physician
  • Naples, FL
  • NPI 1871540377
  Medicare reassignment NPD Authorized official
• Peter John Jaffe, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Naples, FL
  • NPI 1851443337
  NPD (past)

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447113600000",
    "number": "1639125735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 CYPRESS WAY E",
            "address_2": "SUITE 50",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341109275",
            "telephone_number": "239-598-3200",
            "fax_number": "239-598-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 CYPRESS WAY E",
            "address_2": "SUITE 50",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341109275",
            "telephone_number": "239-598-3200",
            "fax_number": "239-598-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGIC & COSMETIC INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2015-11-10",
        "status": "A",
        "authorized_official_last_name": "PRODANOVICH",
        "authorized_official_first_name": "SRDJAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-598-3200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": "ME95851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DG2330",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Advance Medical of Naples
• Advance Medical of Naples
• Advance Medical of Naples LLC
• Advanced Chiropractic Health & Awareness Center, LLC
• Advanced Critical Care Lung and Sleep, LLC
• Advanced Dermatology & Skin Surgery Specialists PA
• Advanced Direct Primary Care
• Advanced Gastroenterology of Naples, LLC
• Advanced Gynecology Inc
• Advanced Innovation Technologies, LLC (AI Med-Tech)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.