Southeastern Dermatology, PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHEASTERN DERMATOLOGY, PA

Practice address

2040 Fleischmann Rd
Tallahassee, FL 32308-4599

Phone

(850) 422-3376

Fax

(850) 205-7182

NPI assigned

Jul 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael J Ford, MDNPI 1508868860

Title

Medical Director

Phone

(850) 422-3376

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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

• Michael John Ford, M.D.

  • Dermatology Physician
  • Tallahassee, FL
  • NPI 1508868860
  Medicare reassignment Authorized official
• Brandon James Bergschneider, P.A. - C

  • Medical Physician Assistant
  • Tallahassee, FL
  • NPI 1578981742
  Medicare reassignment
• Christopher Wyatt Jones, P.A.

  • Medical Physician Assistant
  • Tallahassee, FL
  • NPI 1235342114
  Medicare reassignment
• David A Yorio, PA-C

  • Medical Physician Assistant
  • Tallahassee, FL
  • NPI 1639614050
  Medicare reassignment
• Morgan Johnson, PA-C

  • Physician Assistant
  • Tallahassee, FL
  • NPI 1619759784
  NPD (past)

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1841229036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 FLEISCHMANN RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084599",
            "telephone_number": "850-422-3376",
            "fax_number": "850-205-7182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 FLEISCHMANN RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084599",
            "telephone_number": "850-422-3376",
            "fax_number": "850-205-7182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "850-422-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000595501",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "10D0992605",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Radiology Partners LTD
• Southeast Radiology Partners LTD
• Southeast Radiology Partners LTD
• Southeastern Behavioral Health, LLC
• Southeastern Center for Infectious Diseases PA
• Southeastern Outpatient Surgery Center LLC
• Southeastern Plastic Surgery, P.a.
• Southeastern Podiatry Clinic PA
• Southeastern Surgical Group PA
• Southeastern Therapy Services, LLC

• Specialist in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; 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.