NPIMap

Organization Active NPI

Forefront Dermatology, S.C.

Doing business as Gainesville Dermatology, A Forefront Dermatology Practice

  • Dermatology Physician
  • Gainesville, FL
National Provider Identifier
1790388957
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOREFRONT DERMATOLOGY, S.C.
Doing business as
Gainesville Dermatology, A Forefront Dermatology Practice
Practice address
114 NW 76TH Dr
Gainesville, FL 32607-6652
Phone
(352) 332-4442
Fax
(352) 332-4550
NPI assigned
Nov 19, 2020
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Dr. Betsy J Wernli, MDNPI 1437378973
Title
President
Phone
(920) 482-0671

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary
MOHS-Micrographic Surgery Physician 207ND0101X
Procedural Dermatology Physician 207NS0135X

Addresses

Primary practice location

114 NW 76TH Dr
Gainesville, FL 32607-6652

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Other practice location 1

120 NW 76th Dr
Gainesville, FL 32607-6652
Phone (352) 333-3223

Other names 1

  • Gainesville Dermatology, A Forefront Dermatology Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181019000122 FL Part B Supplier - Clinic/Group Practice 3779471701 Receives reassigned benefits from 49 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miramar Beach, FL; Niceville, FL; Orlando, FL; Panama City Beach, FL; Pensacola, FL; Winter Park, FL; Melbourne, FL; Fort Lauderdale, FL…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0965057Forefront Dermatology SC Corp Dba Gainesville114 NW 76TH Dr, Gainesville, FL 32607ComplianceSep 25, 2027
10D2215649Forefront Dermatology, S C120 NW 76TH Dr, Gainesville, FL 32607Certificate of waiverMar 4, 2027

National Provider Directory

National Provider Directory

Locations

114 NW 76th Dr
Gainesville, FL 32607
Phone (352) 332-4442

120 NW 76th Dr
Gainesville, FL 32607
Phone (352) 333-3223

Practitioners & affiliated clinicians

Practitioners 2

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": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1790388957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 NW 76TH DR",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326076652",
            "telephone_number": "352-332-4442",
            "fax_number": "352-332-4550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 NW 76th Dr",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326076652",
            "country_code": "US",
            "telephone_number": "352-333-3223",
            "fax_number": "352-332-4550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "WERNLI",
        "authorized_official_first_name": "BETSY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-482-0671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gainesville Dermatology, A Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gainesville Dermatology, A Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.