STATE WIDE DERMATOLOGY LLC
NPI 1427473073
Dermatology in Odessa, FL

Active since February 19, 2014
17121 RAINBOW TER, ODESSA, FL 33556(813) 749-6907(813) 475-7831 Get Directions Write a Review

NPPES record last updated: July 28, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About State Wide Dermatology Llc NPPES

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

STATE WIDE DERMATOLOGY LLC (NPI 1427473073) is a healthcare organization registered as a dermatology in Odessa, Florida and active in the NPI registry since February 2014. The organization lists Kathleen Y Harrell, Owner, as its authorized official.

NPPES Registry Identity

NPI1427473073
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSTATE WIDE DERMATOLOGY LLC
Location Address17121 RAINBOW TEROdessa, FL 33556-2107
Mailing Address17121 Rainbow TerOdessa, FL 33556-2107 · (813) 749-6907 · Fax (813) 475-7831
Fax(813) 475-7831
Organization SubpartNo
Authorized OfficialKathleen Y HarrellOwner · (813) 749-6907
Enumeration DateFebruary 19, 2014
Last NPPES UpdateJuly 28, 2014
✔ NPI 1427473073 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
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.
17121 RAINBOW TER, Odessa, FL 33556

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

State Wide Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to State Wide Dermatology LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Nurse Practitioner
NPI 1144812868
17121 RAINBOW TER
Odessa, FL 33556
(813) 601-3982
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1932728193
17121 RAINBOW TER
Odessa, FL 33556
(813) 749-6907
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1043295090
17121 RAINBOW TERRACE
Odessa, FL 33556
(813) 749-6707
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1538829098
4626 14TH ST N
St Petersburg, FL 33703
(727) 422-1438
✔ PECOS✔ Accepts Medicare21 mi
Nurse Practitioner
NPI 1225773617
5002 SE 38TH ST
Ocala, FL 34480
(352) 239-1718
✔ PECOS✔ Accepts Medicare78 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 State Wide Dermatology LLC's NPI number?

The NPI number for State Wide Dermatology LLC is 1427473073. It was assigned to this organization in the NPPES registry on February 19, 2014.

Where is State Wide Dermatology LLC located?

State Wide Dermatology LLC is located at 17121 Rainbow Ter, Odessa, FL 33556. The listed phone number is (813) 749-6907.

What is State Wide Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is State Wide Dermatology LLC enrolled in Medicare?

Yes. State Wide Dermatology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through State Wide Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians, all in Nurse Practitioner, reassign their Medicare billing to State Wide Dermatology LLC. 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, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does State Wide Dermatology LLC accept?

Health plans from AmeriHealth Caritas Next list State Wide Dermatology LLC 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 State Wide Dermatology LLC was last updated on July 28, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.