Active NPI
Leavitt Medical Associates of Florida Inc
- Dermatology Physician
- Melbourne, FL
National Provider Identifier
1881925006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- Practice address
- 1515 W Nasa Blvd
Ste 100
Melbourne, FL 32901-2605 - Phone
- (321) 308-0659
- Fax
- (321) 309-2881
- NPI assigned
- Jan 28, 2010
- Organization subpart
- Yes
- Parent organization
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nefrita Logan
- Title
- Provider Service Rep
- Phone
- (407) 875-2080
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | FL | Primary |
Addresses
Primary practice location
1515 W Nasa Blvd
Ste 100
Melbourne, FL 32901-2605
Mailing address
151 Southhall LN
Ste 300
Maitland, FL 32751-7176
Phone (407) 875-2080
Other names 1
- Advanced Dermatology and Cosmetic Suregery
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| 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
National Provider Directory- Part of
- Leavitt Medical Associates of Florida Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264636800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1386547200000",
"number": "1881925006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 SOUTHHALL LN",
"address_2": "STE 300",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327517176",
"telephone_number": "407-875-2080",
"fax_number": "407-650-3455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 W NASA BLVD",
"address_2": "STE 100",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329012605",
"telephone_number": "321-308-0659",
"fax_number": "321-309-2881"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
"enumeration_date": "2010-01-28",
"last_updated": "2013-12-09",
"status": "A",
"authorized_official_last_name": "LOGAN",
"authorized_official_first_name": "NEFRITA",
"authorized_official_title_or_position": "PROVIDER SERVICE REP",
"authorized_official_telephone_number": "407-875-2080"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Dermatology and Cosmetic Suregery",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.