NPIMap

Organization Active NPI

Blue Ocean Dermatology LLC

  • Dermatology Physician
  • Port Orange, FL
National Provider Identifier
1992045272
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BLUE OCEAN DERMATOLOGY LLC
Practice address
3951 S Nova Rd
Suite 3
Port Orange, FL 32127
Phone
(386) 256-1444
NPI assigned
Feb 22, 2013
Last updated
Aug 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Authorized official

Name
Nitra H WelchNPI 1821141714
Title
Cfo
Phone
(386) 256-1444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X

Addresses

Primary practice location

3951 S Nova Rd
Suite 3
Port Orange, FL 32127

Mailing address

3951 S Nova Rd
Suite 3
Port Orange, FL 32127-9270
Phone (386) 256-1444

Other practice location 1

1004 N Parrott Ave
Okeechobee, FL 34972-2110
Phone (863) 226-5466

Other practice location 2

1840 Greenwich Ave
Winter Park, FL 32789-4012
Phone (407) 644-4212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130423000030 FL Part B Supplier - Clinic/Group Practice 3779729603 Receives reassigned benefits from 25 practitioners
Practice locations: Winter Park, FL; Port Orange, FL; Ormond Beach, FL; Okeechobee, FL; Daytona Beach, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2066545Blue Ocean Dermatology LLC3951 S Nova Rd Ste 3, Port Orange, FL 32127ComplianceFeb 5, 2028
10D2149326Blue Ocean Dermatology LLC1840 Greenwich Ave, Winter Park, FL 32789ComplianceFeb 26, 2027

National Provider Directory

National Provider Directory

Locations

1425 Hand Ave
Ste C
Ormond Beach, FL 32174
Phone 3862561444110

57 Town Ct
Palm Coast, FL 32164

3951 S Nova Rd
Ste 3
Port Orange, FL 32127

4110 US 27 N
Ste 102
Sebring, FL 33870

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1361491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1992045272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3951 S NOVA RD",
            "address_2": "SUITE 3",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279270",
            "telephone_number": "386-256-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3951 S NOVA RD",
            "address_2": "SUITE 3",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32127",
            "telephone_number": "386-256-1444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1004 N Parrott Ave",
            "address_purpose": "LOCATION",
            "city": "Okeechobee",
            "state": "FL",
            "postal_code": "349722110",
            "country_code": "US",
            "telephone_number": "863-226-5466",
            "fax_number": "321-400-1118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1840 Greenwich Ave",
            "address_purpose": "LOCATION",
            "city": "Winter Park",
            "state": "FL",
            "postal_code": "327894012",
            "country_code": "US",
            "telephone_number": "407-644-4212",
            "fax_number": "321-400-1118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE OCEAN DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-22",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "WELCH",
        "authorized_official_first_name": "NITRA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "386-256-1444"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; 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.