Individual provider Active NPI

Andrew Todd Jaffe, M.D.

  • MOHS-Micrographic Surgery Physician
  • Palm Beach Gardens, FL
National Provider Identifier
1699741405
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
ME78335 Issued in FL
Practice address
900 Village Square Xing Ste 290
Palm Beach Gardens, FL 33410-4552
Phone
(392) 321-1802
NPI assigned
Feb 23, 2006
Last updated
Oct 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X ME78335 FL Primary

Addresses

Primary practice location

900 Village Square Xing Ste 290
Palm Beach Gardens, FL 33410-4552

Mailing address

900 Village Square Xing Ste 290
Palm Beach Gardens, FL 33410-4552
Phone (392) 321-1802

Other identifiers 3

IdentifierTypeStateIssuer
ME 78335OtherFLMEDICAL LICENSE
51838ZOtherFLMEDICARE PTAN
ME78335OtherFLLICENSE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041002000107 FL Practitioner - Dermatology 2062481328 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Aqua Dermatology of Florida, PA CurrentSince Aug 16, 2004 Accepting new patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince May 26, 2000 Accepting new patients
Cary L Dunn M D P a Mohs-Micrographic Surgery PastSince May 4, 2014 Accepting new patients
Water's Edge Dermatology, LLC PastSince Oct 22, 2023 Accepting new patients

Locations

15051 S Tamiami Trl
Ste 203
Fort Myers, FL 33908
Phone (239) 732-5959

9400 Gladiolus Dr
Ste 320
Fort Myers, FL 33908
Phone (239) 482-7546

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

261 9th St S
Naples, FL 34102
Phone (239) 216-4337

900 Village Square Xing
Ste 290
West Palm Beach, FL 33410
Phone (239) 313-2517

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: ajaffe@aquadermatology.emadirect.md

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1699741405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 VILLAGE SQUARE XING STE 290",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104552",
            "telephone_number": "392-321-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 VILLAGE SQUARE XING STE 290",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104552",
            "telephone_number": "392-321-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAFFE",
        "first_name": "ANDREW",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME78335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME 78335",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "51838Z",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ME78335",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Beach Gardens, FL

Sources for this page

Verify at the official NPI Registry.