NPIMap

Organization Active NPI

Genesis Dermatology

  • Dermatology Physician
  • Jupiter, FL
National Provider Identifier
1801093661
Registry record updated Feb 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GENESIS DERMATOLOGY
Practice address
600 Heritage Dr
Suite 100
Jupiter, FL 33458-3000
Phone
(561) 296-5222
Fax
(561) 296-5221
NPI assigned
Jun 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2012

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

Authorized official

Name
Shawna Flanagan, MDNPI 1699754481
Title
Owner
Phone
(561) 296-5222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

600 Heritage Dr
Suite 100
Jupiter, FL 33458-3000

Mailing address

600 Heritage Dr
Suite 100
Jupiter, FL 33458-3000
Phone (561) 296-5222

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040914000305 FL Part B Supplier - Clinic/Group Practice 8527035146 Receives reassigned benefits from 4 practitioners
Practice locations: Jupiter, FL

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
10D0953693Genesis Dermatology600 Heritage Dr Ste 101, Jupiter, FL 33458ComplianceFeb 3, 2027

National Provider Directory

National Provider Directory

Locations

600 Heritage Dr
Ste 100
Jupiter, FL 33458
Phone (561) 296-5232

600 Heritage Dr
Ste 101
Jupiter, FL 33458
Phone (561) 296-5222

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1801093661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HERITAGE DR",
            "address_2": "SUITE 100",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334583000",
            "telephone_number": "561-296-5222",
            "fax_number": "561-296-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HERITAGE DR",
            "address_2": "SUITE 100",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334583000",
            "telephone_number": "561-296-5222",
            "fax_number": "561-296-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "FLANAGAN",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-296-5222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jupiter, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; 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.