Unknown Individual – Dermatology Physician, NPI 1366647562
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
2621, Cleveland Avenue, Edison Park Historic District, Fort Myers, Lee County, Florida, 33901, United States
FORT MYERS, FL 33901
Phone: (239) 425-1270
Type: Location
11490, Villa Grand, Royal Greens at Gateway, Gateway, Fort Myers, Lee County, Florida, 33913, United States
APT 209
FORT MYERS, FL 33913
Phone:
Type: Mailing
1 FORD PL STE 2E
DETROIT, MI 482023450
Phone:
Type: Mailing
3333 SPRING ARBOR RD
JACKSON, MI 492038605
Phone: (517) 205-2106
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $141.
Total Amount is formed as General ($141) + Research ($0) + Ownership ($0) = $141.
Last reported payment date: 2024-05-01 • Largest payer in this snapshot: UCB, Inc. ($94).
Total Amount
$141
General + Research + Ownership
Payments
5
Total payment records
General Amount
$141
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-01
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| UCB, Inc. | $94 |
| Janssen Biotech, Inc. | $27 |
| ABBVIE INC. | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33901)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | FL | 17003 | Destruction of 2-14 skin growths | 190 | 47 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MI | |
| D E R M A T O L O G Y | TX | |
| Dermatology, Dermatology, Pathology | VA | |
| Physician Assistant | MN | |
| Plastic And Reconstructive Surgery | IL | |
| Nurse Practitioner | MI | |
| D E R M A T O L O G Y | AZ | |
| Physician Assistant | MN | |
| Physician Assistant | IN | |
| - | IN |
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