Lakeside Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME0058778 Issued in FL

Legal business name

LAKESIDE DERMATOLOGY LLC

Practice address

727 US 27 S
Sebring, FL 33870-2169

Phone

(863) 385-7183

Fax

(863) 385-0088

NPI assigned

Sep 11, 2008

Last updated

Dec 19, 2024By 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

Michael Joseph Rogers, MDNPI 1003876053

Title

Sole MBR

Phone

(863) 385-7183

Specialties & licenses 2

Addresses

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 8

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.

• Michael J Rogers

  • Dermatology Physician
  • Sebring, FL
  • NPI 1003876053
  Medicare reassignment Care Compare group NPD Authorized official
• Alexander Woodward Kennon, M.D.

  • MOHS-Micrographic Surgery Physician
  • Sebring, FL
  • NPI 1053675868

  Dermatology

  Medicare reassignment Care Compare group NPD
• Brooke Rogers, DNP,FNP-C

  • Nurse Practitioner
  • Sebring, FL
  • NPI 1184038119
  Medicare reassignment Care Compare group NPD
• Barbara Ann Ross, NP

  • Nurse Practitioner
  • Winter Haven, FL
  • NPI 1457579955
  Medicare reassignment Care Compare group NPD
• Erin Atallah, DNP, APRN

  • Family Nurse Practitioner
  • Winter Haven, FL
  • NPI 1639009616
  NPD
• Bobbi Jo Darr

  • Family Nurse Practitioner
  • Orange City, FL
  • NPI 1659756377
  NPD
• Kristi Darlene Lewis, ARNP-C

  • Nurse Practitioner
  • Tampa, FL
  • NPI 1659348167
  NPD (past)
• Patricia A Mulder, ARNP-C

  • Nurse Practitioner
  • Sebring, FL
  • NPI 1841434727
  NPD (past)

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

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1922257260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 US 27 S",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338702169",
            "telephone_number": "863-385-7183",
            "fax_number": "863-385-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 US 27 S",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338702169",
            "telephone_number": "863-385-7183",
            "fax_number": "863-385-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "863-385-7183",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME0058778",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "ME0058778",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Irwin Ladinsky, PT
• Susie Lorevi Imperio Lagabon, RPH
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• Lakeview Idd Therapy Center P.a.
• Lakeview Occupational and Industrial Clinic Dba a Plus Occupational an (A Plus Occupational and Industrial Rehabilitation Center)
• Lakeview Occupational and Industrial Clinic, P.a.
• Lakeview Orthopaedic and Hand Center, P.a.
• Harini Gayithri Lakshman, MD

• Dermatology Physician in Sebring, FL
• Providers in Sebring, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; 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.