Leavitt Medical Associates of Florida Inc
Organization Active NPI Dermatology Physician · The Villages, FL
NPI 1700044286 · NPPES record last updated Apr 21, 2010
Key facts
- NPI
- 1700044286
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- Practice address
- 1503 Buenos Aires Blvd
The Villages, FL 32159-6821 - Phone
- (352) 753-2812
- Fax
- (352) 753-5037
- NPI assigned
- May 30, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Authorized official
- Name
- Amy Declue
- Title
- Director, Provider Services
- Phone
- (407) 875-2080
Corporate family (same tax ID) 22
Practitioners 6
-
Laini Rae Gaar, M.D.
-
Robert Garrigus, PA
-
Sonya Unnoppet, PA
-
Philomena Walker, PA
-
Kristin Gregory, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D1046283 | Advanced Dermatology & Cosmetic Surgery | Accreditation | Jun 23, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Leavitt Medical Associates of Florida Inc
- Part of
- Leavitt Medical Associates of Florida Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Pediatric Dermatology Physician |
207NP0225X |
Addresses
Primary practice location
1503 Buenos Aires Blvd
The Villages, FL 32159-6821
Mailing address
2600 Lake Lucien Dr Ste 180
Maitland, FL 32751-7235
Phone (407) 875-2080
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 256877220 | Medicaid | FL |
Other names
- Advanced Dermatology and Cosmetic Surgery
Other providers in The Villages, FL
- Laurel Manor Center for Comprehensive Denistry, P.a.
- Kaitlyn Elizabeth Lawson
- Susan Kay Lawson
- Lco Group, PA
- Leavitt Medical Associates of Florida Inc
- Jaime Leavitt
- Andrea Christine Leclair
- Brooke Ashley Leever
- Legacy Healthcare Services Inc
- Justin J Lenhart
All providers in The Villages, FL · Dermatology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.