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BONITA DERMATOLOGY, P.A.
NPI 1073883617
Specialist in Bonita Springs, FL

Active since January 12, 2012
9411 FOUNTAIN MEDICAL CT STE 100, BONITA SPRINGS, FL 34135(239) 593-1632 Get Directions Write a Review

NPPES record last updated: February 16, 2012. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Bonita Dermatology, P.a. NPPES

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

BONITA DERMATOLOGY, P.A. (NPI 1073883617) is a healthcare organization registered as a specialist in Bonita Springs, Florida and active in the NPI registry since January 2012. The organization lists Suzy Pope Lee, Employee, as its authorized official.

NPPES Registry Identity

NPI1073883617
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameBONITA DERMATOLOGY, P.A.
Location Address9411 FOUNTAIN MEDICAL CT STE 100Bonita Springs, FL 34135-4625
Mailing Address9411 Fountain Medical Ct Ste 100Bonita Springs, FL 34135-4625 · (239) 593-1632
Phone(239) 593-1632
Organization SubpartNo
Authorized OfficialSuzy Pope LeeEmployee · (239) 593-1632
Enumeration DateJanuary 12, 2012
Last NPPES UpdateFebruary 16, 2012
✔ NPI 1073883617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
9411 FOUNTAIN MEDICAL CT STE 100, Bonita Springs, FL 34135
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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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bonita Dermatology, P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Bonita Dermatology, P.A., which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Suzy Lee, M.D.
Dermatology
NPI 1730185133
9411 FOUNTAIN MEDICAL CT STE E100
Bonita Springs, FL 34135
(239) 221-8516
✔ PECOS✔ Accepts MedicareSame address
Brian Lee
Internal Medicine
NPI 1174521066
9240 BONITA BEACH RD SE SUITE 2206
Bonita Springs, FL 34135
(239) 948-5505
✔ PECOS0.3 mi

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

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 Bonita Dermatology, P.A.'s NPI number?

The NPI number for Bonita Dermatology, P.A. is 1073883617. It was assigned to this organization in the NPPES registry on January 12, 2012.

Where is Bonita Dermatology, P.A. located?

Bonita Dermatology, P.A. is located at 9411 Fountain Medical Ct Ste 100, Bonita Springs, FL 34135. The listed phone number is (239) 593-1632.

What is Bonita Dermatology, P.A.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Bonita Dermatology, P.A. enrolled in Medicare?

Yes. Bonita Dermatology, P.A. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Bonita Dermatology, P.A.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Bonita Dermatology, P.A., in Dermatology and Internal Medicine. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Bonita Dermatology, P.A. was last updated on February 16, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.