FLORIDA DERMATOLOGY & SKIN CANCER CENTERS – MOHS-Micrographic Surgery Physician, NPI 1205066404
MOHS-Micrographic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for FLORIDA DERMATOLOGY & SKIN CANCER CENTERS
1052 Downing Cir
Wauchula, FL 338733358
Phone: (855) 353-7546
Fax: (863) 774-3526
Type: Location
3200 Medical Way
Sebring, FL 338703375
Phone: (855) 353-7546
Fax: (863) 333-6520
Type: Location
6020 Park Blvd N
Pinellas Park, FL 337813228
Phone: (855) 353-7546
Fax: (727) 478-2909
Type: Location
421 Linden Ln
Lake Wales, FL 338534342
Phone: (855) 353-7546
Fax: (863) 676-1015
Type: Location
836 Highway 466
Lady Lake, FL 321593918
Phone: (855) 353-7546
Fax: (352) 775-4413
Type: Location
931 S US Highway 41
Inverness, FL 344506860
Phone: (855) 353-7546
Fax: (352) 637-0788
Type: Location
2502 Sand Mine Rd
Davenport, FL 338973402
Phone: (855) 353-7546
Fax: (863) 216-5896
Type: Location
3725 S Hwy 27 Ste 105
Clermont, FL 347117600
Phone: (855) 353-7546
Fax: (352) 533-4391
Type: Location
26800 S Tamiami Trl Ste 360
Bonita Springs, FL 341344355
Phone: (855) 353-7546
Fax: (239) 676-0208
Type: Location
609 Indian Rocks Rd
Belleair, FL 337562056
Phone: (855) 353-7546
Fax: (727) 315-0911
Type: Location
700 SE 5th Ter # 78
Crystal River, FL 344294878
Phone: (855) 353-7546
Fax: (352) 364-9202
Type: Location
1450, 6th Street Southeast, Winter Haven, Polk County, Florida, 33880, United States
WINTER HAVEN, FL 338804505
Phone: (863) 293-2147
Fax: (863) 294-2767
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: 2009-12-19
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 |
|---|---|---|---|---|
| O20091219000120 | O | Clinic/Group Practice | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33873)
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