PROMENADES DERMATOLOGY, LLC
NPI 1720799232
Dermatology in Port Charlotte, FL

Active since December 06, 2022
3222 TAMIAMI TRL, PORT CHARLOTTE, FL 33952(941) 627-5155 Get Directions Write a Review

NPPES record last updated: December 6, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Promenades Dermatology, Llc NPPES

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

PROMENADES DERMATOLOGY, LLC (NPI 1720799232) is a healthcare organization registered as a dermatology in Port Charlotte, Florida and active in the NPI registry since December 2022. The organization lists Bernice Baroudi, Physician, as its authorized official.

NPPES Registry Identity

NPI1720799232
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePROMENADES DERMATOLOGY, LLC
Location Address3222 TAMIAMI TRLPort Charlotte, FL 33952-8048
Mailing Address3222 Tamiami TrlPort Charlotte, FL 33952-8048 · (941) 627-5155
Organization SubpartNo
Authorized OfficialBernice BaroudiPhysician · (941) 627-5155
Enumeration DateDecember 6, 2022
NPPES CertifiedDecember 6, 2022
✔ NPI 1720799232 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.
3222 TAMIAMI TRL, Port Charlotte, FL 33952

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)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Promenades Dermatology, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1053806000
3222 TAMIAMI TRL
Port Charlotte, FL 33952
(941) 627-5155
✔ PECOS✔ Accepts MedicareSame address

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 Promenades Dermatology, LLC's NPI number?

The NPI number for Promenades Dermatology, LLC is 1720799232. It was assigned to this organization in the NPPES registry on December 6, 2022.

Where is Promenades Dermatology, LLC located?

Promenades Dermatology, LLC is located at 3222 Tamiami Trl, Port Charlotte, FL 33952. The listed phone number is (941) 627-5155.

What is Promenades Dermatology, LLC's specialty?

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

Is Promenades Dermatology, LLC enrolled in Medicare?

Yes. Promenades Dermatology, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Promenades Dermatology, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Promenades 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Promenades Dermatology, LLC was last updated on December 6, 2022. 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.