BELLAVISTA DERMATOLOGY GROUP LLC (NPI# 1801379409) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801379409 |
| Entity Type | Organization |
| Organization Name | BELLAVISTA DERMATOLOGY GROUP LLC |
| Other Organization Name | BELLAVISTA DERMATOLOGY |
| Practice Address |
3636 University Blvd S Unit B2 Jacksonville FL 32216 |
| Practice Telephone | 9042971415 |
| Mailing Telephone | 9042971415 |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2018-09-10 |
| Authorized Official Name | MR. RIGEL MARTINEZ (OWNER) |
| Authorized Official Telephone | 9042971415 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NI0002X |
Dermatology Specialization: Clinical & Laboratory Dermatological Immunology |
Allopathic & Osteopathic Physicians | ||
| N | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Bellavista Dermatology | Doing Business As Name - Organization |
| Street Address |
3636 UNIVERSITY BLVD S UNIT B2 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023016987 | Samuel D Kulick | Podiatrist | 3636 University Blvd S, Bldg C, Jacksonville, FL 32216-4250 | 2005-07-13 |
| 1902458722 | Covenant Home Health Care 4, LLC | Home Health | 3636 University Blvd S, Jacksonville, FL 32216-4250 | 2019-07-11 |
| 1639528532 | Precision Eyewear of Wolchok Eye, LLC | Eyewear Supplier (Equipment, not the service) | 3636 University Blvd S, Suite A2, Jacksonville, FL 32216-4250 | 2016-06-10 |
| 1619371465 | Swapnilkumar P Patel | Podiatrist | 3636 University Blvd S, Bldg C, Jacksonville, FL 32216-4250 | 2014-10-22 |
| 1780958314 | Indian Rehabilitation Center, Inc | Clinic/Center | 3636 University Blvd S, Ste A7, Jacksonville, FL 32216-4250 | 2012-02-29 |
| 1689942302 | Adler Podiatry Clinic Pllc | Podiatrist | 3636 University Blvd S, Bldg C, Jacksonville, FL 32216-4250 | 2011-12-08 |
| 1255567301 | Adler Podiatry and Wound Care LLC | Podiatrist | 3636 University Blvd S, Bldg C, Jacksonville, FL 32216-4250 | 2009-06-03 |
| 1356503007 | Osvaldo Contarini Md Pa | Surgery | 3636 University Blvd S, Bldg B, Jacksonville, FL 32216-4250 | 2008-06-25 |
| 1558491258 | Myron F Mass Md Pa | Allergy & Immunology | 3636 University Blvd S, Suite B-2, Jacksonville, FL 32216-4250 | 2007-03-06 |
| 1740324102 | Stephen Mark Wolchok | Ophthalmology | 3636 University Blvd S, A2, Jacksonville, FL 32216-4250 | 2007-02-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902291784 | Brandon Tyler Beal | Dermatology | 6817 Southpoint Pkwy Ste 101, Jacksonville, FL 32216-6285 | 2015-03-30 |
| 1194079988 | Intracoastal Dermatology, Pllc | Dermatology | 4776 Hodges Blvd Ste 105, Jacksonville, FL 32224-7218 | 2012-11-01 |
| 1780861781 | Jacksonville Skin Cancer Center, P.a. | Dermatology | 4465 Baymeadows Rd Ste 5, Jacksonville, FL 32217-4727 | 2008-01-22 |
| 1720272644 | John Morello | Dermatology | 13111 Atlantic Blvd., Ste 4, Jacksonville, FL 32225 | 2007-09-04 |
| 1982740775 | Michael Edward Lutz | Dermatology | 4465 Baymeadows Rd, Suite 5, Jacksonville, FL 32217 | 2007-01-29 |
| 1386757540 | Joy R Boyne | Dermatology | 6869 Belfort Oaks Pl, Jacksonville, FL 32216-6242 | 2006-08-15 |
| 1124063391 | Robert Alan Baker | Dermatology | 11701-32 San Jose Blvd, Suite 216, Jacksonville, FL 32223 | 2006-06-19 |
| 1770521163 | James W Trimble | Dermatology | 6890 Belfort Oaks Pl, Jacksonville, FL 32216-6241 | 2006-06-04 |
| 1497709778 | Daniel J Abraham | Dermatology | 215b Station St, Jacksonville, NC 28546-6304 | 2006-05-20 |
| 1124076492 | Michael A. Gromet | Dermatology | 10036 Scott Mill Rd, Jacksonville, FL 32257-5885 | 2006-05-05 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.