NPIMap

Organization Active NPI

Leavitt Medical Associates of Florida Inc

Doing business as Advanced Dermatology and Cosmetic Surgery

  • Dermatology Physician
  • Bay Harbor Islands, FL
National Provider Identifier
1659513455
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Doing business as
Advanced Dermatology and Cosmetic Surgery
Practice address
1080 Kane Concourse
Bay Harbor Islands, FL 33154-2107
Phone
(305) 864-6200
Fax
(305) 864-9906
NPI assigned
Mar 26, 2009
Last updated
Dec 4, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Amy Declue
Title
Director, Provider Services
Phone
(407) 875-2080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

1080 Kane Concourse
Bay Harbor Islands, FL 33154-2107

Mailing address

151 Southhall LN
Ste 300
Maitland, FL 32751-7176
Phone (407) 875-2080

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

National Provider Directory

National Provider Directory
Tax ID family
Leavitt Med Aso of FL Inc23 organizations share this tax ID, including this one
Part of
Leavitt Med Aso of FL Inc

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Practitioners & affiliated clinicians

Practitioners 5

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": "1238025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1659513455",
    "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": "327517176",
            "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": "1080 KANE CONCOURSE",
            "city": "BAY HARBOR ISLANDS",
            "state": "FL",
            "postal_code": "331542107",
            "telephone_number": "305-864-6200",
            "fax_number": "305-864-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "enumeration_date": "2009-03-26",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER SERVICES",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Cosmetic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bay Harbor Islands, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.