NPIMap

Organization Active NPI

Gina Sevigny M D P a

Doing business as Ormond Beach Dermatology

  • MOHS-Micrographic Surgery Physician
  • Ormond Beach, FL
National Provider Identifier
1649314212
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
ME69303 Issued in FL
Legal business name
GINA SEVIGNY M D P A
Doing business as
Ormond Beach Dermatology
Practice address
305 Clyde Morris Blvd
Suite 150
Ormond Beach, FL 32174-8181
Phone
(386) 615-1771
NPI assigned
Feb 16, 2007
Last updated
Jan 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Authorized official

Name
Ms. Sandra M Adams
Title
Manager
Phone
(386) 615-1771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X ME69303 FL Primary

Addresses

Primary practice location

305 Clyde Morris Blvd
Suite 150
Ormond Beach, FL 32174-8181

Mailing address

305 Clyde Morris Blvd
Suite 150
Ormond Beach, FL 32174-8181
Phone (386) 615-1771

Other practice location 1

900 N Swallow Tail Dr
Port Orange, FL 32129-6102
Phone (386) 615-1771

Other names 1

  • Ormond Beach Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071002000656 FL Part B Supplier - Clinic/Group Practice 1850496076 Receives reassigned benefits from 8 practitioners
Practice locations: Ormond Beach, FL; Port Orange, FL

National Provider Directory

National Provider Directory

Locations

305 Clyde Morris Blvd
Ste 150
Ormond Beach, FL 32174
Phone (386) 615-1771

900 N Swallow Tail Dr
Port Orange, FL 32129
Phone (386) 333-9717

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1649314212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 CLYDE MORRIS BLVD",
            "address_2": "SUITE 150",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748181",
            "telephone_number": "386-615-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 CLYDE MORRIS BLVD",
            "address_2": "SUITE 150",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748181",
            "telephone_number": "386-615-1771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 N Swallow Tail Dr",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "321296102",
            "country_code": "US",
            "telephone_number": "386-615-1771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GINA SEVIGNY M D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "386-615-1771",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME69303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ormond Beach Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ormond Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.