Organization Active NPI

Reflections Dermatology and Center for Skin Care PLLC

  • Procedural Dermatology Physician
  • Orlando, FL
National Provider Identifier
1992908578
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
OS9674 Issued in FL
Legal business name
REFLECTIONS DERMATOLOGY AND CENTER FOR SKIN CARE PLLC
Practice address
875 Outer Rd
Orlando, FL 32814
Phone
(407) 895-8818
Fax
(407) 291-3800
NPI assigned
Jun 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Authorized official

Name
Dr. Dimitry Michael Palceski, D.O.NPI 1265407290
Title
President
Phone
(407) 895-8818

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X OS9674 FL Primary

Addresses

Primary practice location

875 Outer Rd
Orlando, FL 32814

Mailing address

440 W Morse Blvd
Winter Park, FL 32789-4206
Phone (407) 895-8818

Other practice location 1

440 W Morse Blvd
Winter Park, FL 32789-4206
Phone (407) 895-8818

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071024000513 FL Part B Supplier - Clinic/Group Practice 2062509987 Receives reassigned benefits from 5 practitioners
Practice locations: Orlando, FL; Winter Park, 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
10D1079655Reflections Dermatology and Center for875 Outer Rd, Orlando, FL 32814Certificate of waiverMar 4, 2027
10D2156806Reflections Dermatology and Center for Skin Care440 W Morse Blvd, Winter Park, FL 32789Certificate of waiverOct 24, 2026

National Provider Directory

National Provider Directory

Locations

875 Outer Rd
Orlando, FL 32814
Phone (407) 845-8813

440 W Morse Blvd
Winter Park, FL 32789
Phone (407) 895-8818

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1992908578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W MORSE BLVD",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894206",
            "telephone_number": "407-895-8818",
            "fax_number": "407-291-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 OUTER RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32814",
            "telephone_number": "407-895-8818",
            "fax_number": "407-291-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 W Morse Blvd",
            "address_purpose": "LOCATION",
            "city": "Winter Park",
            "state": "FL",
            "postal_code": "327894206",
            "country_code": "US",
            "telephone_number": "407-895-8818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REFLECTIONS DERMATOLOGY AND CENTER FOR SKIN CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-08",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A",
        "authorized_official_last_name": "PALCESKI",
        "authorized_official_first_name": "DIMITRY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-895-8818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "OS9674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; 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.