Advanced Dermatology & Skin Care Centre – Dermatology Physician, NPI 1154815546
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Advanced Dermatology & Skin Care Centre
4400 E Highway 20 Ste 209
Niceville, FL 32578
Phone: (850) 502-5989
Fax: (850) 266-6301
Type: Location
4592 E Highway 20 Ste 3
Niceville, FL 325787711
Phone: (850) 389-4955
Fax: (850) 266-6301
Type: Location
7720 US HIGHWAY 98 W STE 240
MIRAMAR BEACH, FL 325507232
Phone: (850) 502-5989
Fax: (850) 266-6301
Type: Location
801, York Street, Manitowoc, Manitowoc County, Wisconsin, 54220, United States
MANITOWOC, WI 542204630
Phone: (920) 663-9008
Fax: (920) 684-1439
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2018-10-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-08-31 (646 days ago).
Enrollment records
1
Earliest due date
2024-08-31
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 |
|---|---|---|---|---|
| O20181019000122 | O | Clinic/Group Practice | FL | 2024-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 32578)
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