Individual provider Active NPI

Dreama Sue Jenkins-Pilcher, MD

  • Dermatology Physician
  • Jacksonville, FL
National Provider Identifier
1891733341
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME68393 Issued in FL
Practice address
1550 Riverside Ave
Suite a
Jacksonville, FL 32204-4161
Phone
(904) 923-6647
NPI assigned
Jun 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X ME68393 FL Primary

Addresses

Primary practice location

1550 Riverside Ave
Suite a
Jacksonville, FL 32204-4161

Mailing address

1550 Riverside Ave
Suite a
Jacksonville, FL 32204-4161
Phone (904) 923-6647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040521001122 FL Practitioner - Dermatology 1254222128 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Precision Dermatology and Skin Surgery PA Dermatology CurrentSince Jan 1, 2015 Accepting new patients

Locations

1550 Riverside Ave
Ste A
Jacksonville, FL 32204
Phone (904) 613-3996

1209 Park Ave
Orange Park, FL 32073
Phone (904) 278-7012

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443398400000",
    "number": "1891733341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044161",
            "telephone_number": "904-923-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044161",
            "telephone_number": "904-923-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS-PILCHER",
        "first_name": "DREAMA",
        "middle_name": "SUE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-04",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME68393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.