Unknown Individual – Dermatology Physician, NPI 1689688830
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,366 DERMATOLOGY in FL
Provider Addresses for Unknown Individual
2100 DR MARTIN LUTHER KING JR ST N
DIVINE DERMATOLOGY PLLC
ST PETERSBURG, FL 337043264
Phone: (727) 528-0321
Fax: (727) 498-6632
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 28 Open Payments records for all available years, with a total value of $805.
Total Amount is formed as General ($805) + Research ($0) + Ownership ($0) = $805.
Last reported payment date: 2024-12-05 • Largest payer in this snapshot: Arcutis Biotherapeutics, Inc. ($225).
Total Amount
$805
General + Research + Ownership
Payments
28
Total payment records
General Amount
$805
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Arcutis Biotherapeutics, Inc. | $225 |
| Janssen Biotech, Inc. | $185 |
| PFIZER INC. | $162 |
| ABBVIE INC. | $121 |
| Dermavant Sciences, Inc. | $53 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-04-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040422000236 | I | Dermatology | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 854 | 132 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 542 | 289 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 336 | 180 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 334 | 225 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 218 | 155 | $0 |
Insurance plans in this area (ZIP 33704)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | FL | 11101 | Biopsy of each additional growth of skin and/or tissue | 60 | 47 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | IL | |
| Physician Assistant | FL |
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