JACKSONVILLE SKIN CANCER CENTER, P.A.
NPI 1780861781
Dermatology - MOHS-Micrographic Surgery in Jacksonville, FL
NPI Status: Active since January 22, 2008
Contact Information
4465 BAYMEADOWS RD STE 5
JACKSONVILLE, FL
ZIP 32217
Phone: (904) 737-0111
Fax: (904) 737-4422
- Organization
- Dermatology
- MOHS-Micrographic Surgery
- Accepts Insurance
- CLIA Number: 10D1007515
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 01-05-2027
About JACKSONVILLE SKIN CANCER CENTER, P.A.
This page provides the complete NPI Profile along with additional information for Jacksonville Skin Cancer Center, P.a., a provider established in Jacksonville, Florida operating as a Dermatology, focusing in mohs-micrographic surgery . The healthcare provider is registered in the NPI registry with number 1780861781 assigned on January 2008. The practitioner's primary taxonomy code is 207ND0101X. The provider is registered as an organization and their NPI record was last updated 14 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Michael Edward Lutz M.d. (President)
- NPI
- 1780861781
- Provider Name
- JACKSONVILLE SKIN CANCER CENTER, P.A.
- Entity Type
- Organization
- Location Address
- 4465 BAYMEADOWS RD STE 5 JACKSONVILLE, FL 32217
- Location Phone
- (904) 737-0111
- Location Fax
- (904) 737-4422
- Mailing Address
- 4465 BAYMEADOWS RD STE 5 JACKSONVILLE, FL 32217
- Mailing Phone
- (904) 737-0111
- Mailing Fax
- (904) 737-4422
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-22-2008
- Last Update Date
- 12-21-2012
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology MOHS-Micrographic Surgery
- Taxonomy Code
- 207ND0101X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | |
| 2 | 207ND0900X | Allopathic & Osteopathic Physicians | Dermatology | |
| 3 | 207NS0135X | Allopathic & Osteopathic Physicians | Dermatology |
Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- AvMed Entrust Bronze 600 (2026) - HMO
- AvMed Entrust Bronze 650 (2026) - HMO
- AvMed Entrust Expanded Bronze Standard (2026) - HMO
- AvMed Entrust Gold 125 (2026) - HMO
- AvMed Entrust Gold 125 Dental+Vision (2026) - HMO
- AvMed Entrust Gold Standard (2026) - HMO
- AvMed Entrust Platinum 25 (2026) - HMO
- AvMed Entrust Platinum 25 Dental+Vision (2026) - HMO
- AvMed Entrust Platinum Standard (2026) - HMO
- AvMed Entrust Silver 350 (2026) - HMO
- AvMed Entrust Silver 350 Dental+Vision (2026) - HMO
- AvMed Entrust Silver 550 (2026) - HMO
- AvMed Entrust Silver 550 Dental+Vision (2026) - HMO
- AvMed Entrust Silver Standard (2026) - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| DB9233 | MEDICARE PIN (08) | FL | |
| 42484 | OTHER (01) | FL | BLUE CROSS BLUE SHIELD |
| K5737 | MEDICARE PIN (08) | FL |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D1007515
- Facility Type
- Physician Office
- Certificate Effective Date
- January 06, 2025
- Certificate Expiration Date
- January 05, 2027
- Laboratory Director
- MICHAEL E. LUTZ
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Jacksonville Skin Cancer Center, P.a. after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1780861781, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 69. The final step is to find the difference between that total and the next multiple of ten (70 - 69 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 69 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1780861781, enumerated as an "organization" on January 22, 2008.
The provider is located at 4465 BAYMEADOWS RD STE 5 JACKSONVILLE, FL 32217 and the phone number is (904) 737-0111.
Dermatology with taxonomy code 207ND0101X and a focus in MOHS-Micrographic Surgery.
The provider might be accepting Accepts: AvMed, Medicare, Medicaid and Blue Cross Blue. Please consult your insurance carrier or call the provider to verify.
