Atlantic Derm PLLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

ATLANTIC DERM PLLC

Practice address

16244 S Military TRL Ste 490
Delray Beach, FL 33484-6532

Phone

(561) 802-7546

NPI assigned

Dec 3, 2018

Organization subpart

No

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

Authorized official

Name

Yvette Tivoli, DONPI 1700024833

Title

Owner

Phone

(561) 802-7546

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• Yvette Arlene Tivoli, D.O.

  • Family Medicine Physician
  • Delray Beach, FL
  • NPI 1700024833

  Procedural Dermatology

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1962972992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16244 S MILITARY TRL STE 490",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334846532",
            "telephone_number": "561-802-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16244 S MILITARY TRL STE 490",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334846532",
            "telephone_number": "561-802-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC DERM PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2018-12-03",
        "status": "A",
        "authorized_official_last_name": "TIVOLI",
        "authorized_official_first_name": "YVETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-802-7546",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "OS10758",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Delray Beach, FL
• Providers in Delray Beach, FL by specialty
• Procedural Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; 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.

Verify at the official NPI Registry.