INNOVATIVE DERMATOLOGY AND MOHS SURGERY LLC
NPI 1487049722
Dermatology in Lehigh Acres, FL

Q: What is Innovative Dermatology And Mohs Surgery LLC's specialty?

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

Active since April 03, 2015CLIA Certified · 2 labs

3507 LEE BLVD, STE 107, LEHIGH ACRES, FL 33971(239) 368-8071(239) 368-8074 Get Directions Write a Review

NPPES record last updated: April 3, 2015. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Innovative Dermatology And Mohs Surgery Llc NPPES

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

INNOVATIVE DERMATOLOGY AND MOHS SURGERY LLC (NPI 1487049722) is a healthcare organization registered as a dermatology in Lehigh Acres, Florida and active in the NPI registry since April 2015. The organization holds 2 active CLIA laboratory certificates and lists Andrew P Kontos, Owner, as its authorized official.

NPPES Registry Identity

NPI1487049722

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NameINNOVATIVE DERMATOLOGY AND MOHS SURGERY LLC

Location Address3507 LEE BLVD, STE 107Lehigh Acres, FL 33971-1318

Mailing Address3507 Lee Blvd, Ste 107Lehigh Acres, FL 33971-1318 · (239) 368-8071 · Fax (239) 368-8074

Phone(239) 368-8071

Fax(239) 368-8074

Organization SubpartNo

Authorized OfficialAndrew P KontosOwner · (239) 368-8071

Enumeration DateApril 3, 2015

✔ NPI 1487049722 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in FL · ME96589

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.

3507 LEE BLVD, Lehigh Acres, FL 33971

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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)

Innovative Dermatology And Mohs Surgery Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Innovative Dermatology And Mohs Surgery LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Andrew Kontos, M.D.

Micrographic Dermatologic Surgery (MDS)

NPI 1427164466

3507 LEE BLVD STE 107
Lehigh Acres, FL 33971

(239) 368-8071

✔ PECOS✔ Accepts MedicareSame address

Vanessa Levine, NP

Nurse Practitioner

NPI 1114483906

407 CAPE CORAL PKWY W
Cape Coral, FL 33914

(239) 376-0800

✔ PECOS19 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 2

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 10D2095045

Innovative Dermatology And Mohs Surgery LLC · Lehigh Acres, FL

Active · expires Jun 30, 2027

CLIA Number10D2095045

Laboratory TypePhysician Office

Certificate Effective DateJuly 1, 2025

Certificate Expiration DateJune 30, 2027

Laboratory DirectorDr. Andrew P. Kontos

Laboratory Phone(239) 368-8071

Laboratory LocationInnovative Dermatology And Mohs Surgery LLC3507 Lee Blvd Suite 107, Lehigh Acres, FL 33971

CLIA data matches this NPI record on: Address 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 10D2129545

Innovative Dermatology And Mohs Surgery LLC · Bonita Springs, FL

Active · expires May 24, 2027

CLIA Number10D2129545

Laboratory TypePhysician Office

Certificate Effective DateMay 25, 2025

Certificate Expiration DateMay 24, 2027

Laboratory DirectorDr. Andrew P. Kontos

Laboratory Phone(239) 368-8071

Laboratory LocationInnovative Dermatology And Mohs Surgery LLC8800 Bernwood Parkway Unit 6, Bonita Springs, FL 34135

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 Innovative Dermatology And Mohs Surgery LLC's NPI number?

The NPI number for Innovative Dermatology And Mohs Surgery LLC is 1487049722. It was assigned to this organization in the NPPES registry on April 3, 2015.

Where is Innovative Dermatology And Mohs Surgery LLC located?

Innovative Dermatology And Mohs Surgery LLC is located at 3507 Lee Blvd Ste 107, Lehigh Acres, FL 33971. The listed phone number is (239) 368-8071.

What is Innovative Dermatology And Mohs Surgery LLC's specialty?

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

Is Innovative Dermatology And Mohs Surgery LLC enrolled in Medicare?

Yes. Innovative Dermatology And Mohs Surgery LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Innovative Dermatology And Mohs Surgery LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Innovative Dermatology And Mohs Surgery LLC, in Micrographic Dermatologic Surgery (MDS) and Nurse Practitioner. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Innovative Dermatology And Mohs Surgery LLC hold CLIA laboratory certificates?

Yes. 2 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.

When was this NPI record last updated?

The NPPES record for Innovative Dermatology And Mohs Surgery LLC was last updated on April 3, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.