Orlando Dermatology Clinic, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

ORLANDO DERMATOLOGY CLINIC, LLC

Doing business as

Care Dermatology and Skin Cancer Centers

Practice address

1040 Lake Sumter LNDG
The Villages, FL 32162-2697

Phone

(352) 218-3211

Fax

(877) 699-3709

NPI assigned

Apr 2, 2019

Last updated

May 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tarek Samir Shaath, MDNPI 1366823775

Title

Dermatologist, LLC President

Phone

(785) 760-6740

Specialties & licenses 6

Addresses

Other names 1

• Care Dermatology and Skin Cancer Centers Doing business as

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 4

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.

• Tarek S Shaath, MD

  • Dermatology Physician
  • The Villages, FL
  • NPI 1366823775

  Multi-Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Krismarie Marrero Ramos, FNP-C

  • Family Nurse Practitioner
  • Kissimmee, FL
  • NPI 1649849902
  Medicare reassignment Care Compare group NPD
• Sadie Marie Smith, APRN NP-C

  • Family Nurse Practitioner
  • The Villages, FL
  • NPI 1366057440
  Medicare reassignment Care Compare group NPD
• Riley Moll, APRN FNP-C

  • Family Nurse Practitioner
  • The Villages, FL
  • NPI 1255218947
  NPD (past)

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1891257655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "697 OAK HOLLOW WAY",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327141838",
            "telephone_number": "785-760-6740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 LAKE SUMTER LNDG",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321622697",
            "telephone_number": "352-218-3211",
            "fax_number": "877-699-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLANDO DERMATOLOGY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-02",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "SHAATH",
        "authorized_official_first_name": "TAREK",
        "authorized_official_middle_name": "SAMIR",
        "authorized_official_title_or_position": "DERMATOLOGIST, LLC PRESIDENT",
        "authorized_official_telephone_number": "785-760-6740",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Care Dermatology and Skin Cancer Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashok K. Ojha, M.D.
• Smita Ojha, M.D.
• Denise C. Ollivierre, M.D.
• Ayman I Omar, MD, PHD
• Omega Integrative Care
• Dionne Camille Orr, OD
• Orthocare Orthotics and Prosthetics Inc
• Rafael Angel Ortiz Graulau, M.D.
• Erving Ortiz
• Oxford Pharmacy

• MOHS-Micrographic Surgery Physician in The Villages, FL
• Providers in The Villages, FL by specialty
• MOHS-Micrographic Surgery Physician in Florida

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