NPIMap

Organization Active NPI

Clearwater Dermatology, P.a.

  • Dermatology Physician
  • Clearwater, FL
National Provider Identifier
1780659094
Registry record updated Dec 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME0021279 Issued in FL
Legal business name
CLEARWATER DERMATOLOGY, P.A.
Practice address
1122 Druid Rd E
Clearwater, FL 33756-4100
Phone
(727) 461-2282
NPI assigned
Feb 21, 2006
Last updated
Dec 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2013

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

Authorized official

Name
Dr. Roger Steven Golomb, MDNPI 1841282340
Title
President
Phone
(727) 461-2282

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X ME0021279 FL Primary

Addresses

Primary practice location

1122 Druid Rd E
Clearwater, FL 33756-4100

Mailing address

1122 Druid Rd E
Clearwater, FL 33756-4100
Phone (727) 461-2282

Other identifiers 3

IdentifierTypeStateIssuer
0300627OtherFLUHC GROUP # CLWR DERM
0004563725OtherFLAETNA PROV CLWR DERM
250114700MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388361600000",
    "number": "1780659094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 DRUID RD E",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337564100",
            "telephone_number": "727-461-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 DRUID RD E",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337564100",
            "telephone_number": "727-461-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2013-12-30",
        "status": "A",
        "authorized_official_last_name": "GOLOMB",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-461-2282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME0021279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC GROUP # CLWR DERM",
            "identifier": "0300627",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROV CLWR DERM",
            "identifier": "0004563725",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250114700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.