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PALM BAY DERMATOLOGY
NPI 1073577136
Dermatology - MOHS-Micrographic Surgery in Palm Bay, FL

Active since April 14, 2006CLIA Certified · 3 labs
5070 MINTON RD NW, SUITE 5, PALM BAY, FL 32907(321) 768-1600(321) 768-6418 Get Directions Write a Review

NPPES record last updated: November 10, 2023. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Palm Bay Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PALM BAY DERMATOLOGY (NPI 1073577136) is a healthcare organization registered as a mohs-micrographic surgery in Palm Bay, Florida and active in the NPI registry since April 2006. The organization holds 3 active CLIA laboratory certificates and lists Ruben Moreno, President, as its authorized official.

NPPES Registry Identity

NPI1073577136
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameFLORIDA DERMATOLOGY ASSOCIATES INC
Location Address5070 MINTON RD NW, SUITE 5Palm Bay, FL 32907-1157
Mailing Address5070 Minton Rd Nw, Suite 3aPalm Bay, FL 32907-1157 · (321) 768-1600 · Fax (321) 799-4903
Phone(321) 768-1600
Fax(321) 768-6418
Organization SubpartNo
Authorized OfficialRuben MorenoPresident · (321) 768-1600
Enumeration DateApril 14, 2006
Last NPPES UpdateNovember 10, 2023
NPPES CertifiedNovember 10, 2023
✔ NPI 1073577136 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
License✔ Licensed in FL · ME51282
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
5070 MINTON RD NW, Palm Bay, FL 32907
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Other Names 1

Doing Business AsPalm Bay Dermatology

Other Identifiers 3

Other070002166AFL · Railroad Medicare
Other94928FL · Bcbs
Other169940FL · Wellcare

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Wellpoint.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Palm Bay Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Palm Bay Dermatology, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Robert Taylor, M.D.
Dermatology
NPI 1720189657
5070 MINTON RD NW STE 5
Palm Bay, FL 32907
(941) 484-1510
✔ PECOSSame address
Ruben Moreno, MD
Dermatology
NPI 1225092331
5070 MINTON RD NW SUITE 5
Palm Bay, FL 32907
(321) 768-1600
✔ PECOS✔ Accepts MedicareSame address
Betsy Cooduvalli, DO
Dermatology
NPI 1437410230
500 N WASHINGTON AVE STE 109
Titusville, FL 32796
(321) 768-1600
✔ PECOS41 mi
James Magill, M.D.
Pathology
NPI 1073682514
4800 SW 35TH DR
Gainesville, FL 32608
(352) 265-9900
✔ PECOS✔ Accepts Medicare150 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 10D0938368

Palm Bay Dermatology · Palm Bay, FL
Active · expires Apr 1, 2028
CLIA Number10D0938368
Laboratory TypePhysician Office
Certificate Effective DateApril 2, 2026
Certificate Expiration DateApril 1, 2028
Laboratory DirectorRuben A. Moreno
Laboratory Phone(321) 768-1600
Laboratory LocationPalm Bay Dermatology5070 NW Minton Rd Ste 2, Palm Bay, FL 32907
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 10D0939580

Florida Dermatology Associates Inc · Cocoa Beach, FL
Active · expires Feb 29, 2028
CLIA Number10D0939580
Laboratory TypePhysician Office
Certificate Effective DateMarch 1, 2026
Certificate Expiration DateFebruary 29, 2028
Laboratory DirectorRuben A. Moreno
Laboratory Phone(321) 768-1600
Laboratory LocationFlorida Dermatology Associates Inc80 Woodland Ave, Cocoa Beach, FL 32931
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 10D2092369

Florida Dermatology Associates Inc Dba Suntree Dermatology · Melbourne, FL
Active · expires Apr 27, 2027
CLIA Number10D2092369
Laboratory TypePhysician Office
Certificate Effective DateApril 28, 2025
Certificate Expiration DateApril 27, 2027
Laboratory DirectorRuben A. Moreno
Laboratory Phone(321) 768-1600
Laboratory LocationFlorida Dermatology Associates Inc Dba Suntree Dermatology7640 N Wickham Rd, Melbourne, FL 32940
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Florida Dermatology Associates Inc's NPI number?

The NPI number for Florida Dermatology Associates Inc is 1073577136. It was assigned to this organization in the NPPES registry on April 14, 2006. The provider is doing business as Palm Bay Dermatology.

Where is Florida Dermatology Associates Inc located?

Florida Dermatology Associates Inc is located at 5070 Minton Rd NW Suite 5, Palm Bay, FL 32907. The listed phone number is (321) 768-1600.

What is Florida Dermatology Associates Inc's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Florida Dermatology Associates Inc enrolled in Medicare?

Yes. Florida Dermatology Associates Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Florida Dermatology Associates Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Florida Dermatology Associates Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (3) and Pathology (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Florida Dermatology Associates Inc hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Florida Dermatology Associates Inc accept?

Health plans from Wellpoint list Florida Dermatology Associates Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Florida Dermatology Associates Inc was last updated on November 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.