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SOUTHEASTERN DERMATOLOGY, PA
NPI 1841229036
Specialist in Tallahassee, FL

Active since July 01, 2006CLIA Certified · 3 labs
2040 FLEISCHMANN RD, TALLAHASSEE, FL 32308(850) 422-3376(850) 205-7182 Get Directions Write a Review

NPPES record last updated: June 14, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Southeastern Dermatology, Pa NPPES

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

SOUTHEASTERN DERMATOLOGY, PA (NPI 1841229036) is a healthcare organization registered as a specialist in Tallahassee, Florida and active in the NPI registry since July 2006. The organization holds 3 active CLIA laboratory certificates and lists Michael J Ford, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1841229036
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSOUTHEASTERN DERMATOLOGY, PA
Location Address2040 FLEISCHMANN RDTallahassee, FL 32308-4599
Mailing Address2040 Fleischmann RdTallahassee, FL 32308-4599 · (850) 422-3376 · Fax (850) 205-7182
Phone(850) 422-3376
Fax(850) 205-7182
Organization SubpartNo
Authorized OfficialMichael J FordMedical Director · (850) 422-3376
Enumeration DateJuly 1, 2006
Last NPPES UpdateJune 14, 2016
✔ NPI 1841229036 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.
2040 FLEISCHMANN RD, Tallahassee, FL 32308
Open in Google Maps ↗

Other Identifiers 3

Medicare PINK2914FL
Other10D0992605FL · Clia
Medicaid000595501FL

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

The full list of accepted plans is on the Insurance tab. Issuers include Capital Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateFloridaEnrollment IDO20050310000635Non-DME Part B · Clinic/Group PracticeDue dateJanuary 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA 3

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 10D0992605

Southeastern Dermatology Inc · Tallahassee, FL
Active · expires Dec 17, 2027
CLIA Number10D0992605
Laboratory TypePhysician Office
Certificate Effective DateDecember 18, 2025
Certificate Expiration DateDecember 17, 2027
Laboratory DirectorMichael J. Ford
Laboratory Phone(850) 422-3376
Laboratory LocationSoutheastern Dermatology Inc2040 Fleischmann Rd, Tallahassee, FL 32308
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 for Provider-Performed Microscopy Procedures (PPMP) 10D2059743

Southeastern Dermatology · Perry, FL
Active · expires May 29, 2027
CLIA Number10D2059743
Laboratory TypePhysician Office
Certificate Effective DateMay 30, 2025
Certificate Expiration DateMay 29, 2027
Laboratory DirectorMichael J. Ford
Laboratory Phone(850) 422-3376
Laboratory LocationSoutheastern Dermatology555 N Byron Butler Pkwy, Perry, FL 32347
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 10D2130368

Southeastern Dermatology PA · Crawfordville, FL
Active · expires May 7, 2027
CLIA Number10D2130368
Laboratory TypePhysician Office
Certificate Effective DateMay 8, 2025
Certificate Expiration DateMay 7, 2027
Laboratory DirectorMichael J. Ford
Laboratory Phone(850) 422-3376
Laboratory LocationSoutheastern Dermatology PA2887 Crawfordville Hwy Ste 4, Crawfordville, FL 32327
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. CHRISTOPHER WYATT JONES P.A.
Physician Assistant (Medical)
2040 FLEISCHMANN RD
TALLAHASSEE, FL 32308
Leon County (850) 422-3376
MR. BRANDON JAMES BERGSCHNEIDER P.A. - C
Physician Assistant (Medical)
2040 FLEISCHMANN RD
TALLAHASSEE, FL 32308
Leon County (850) 422-3376
MORGAN JOHNSON PA-C
Physician Assistant
2040 FLEISCHMANN RD
TALLAHASSEE, FL 32308
Leon County (850) 422-3376
MR. DAVID A YORIO PA-C
Physician Assistant (Medical)
2040 FLEISCHMANN RD
TALLAHASSEE, FL 32308
Leon County (850) 422-3376

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 Southeastern Dermatology, PA's NPI number?

The NPI number for Southeastern Dermatology, PA is 1841229036. It was assigned to this organization in the NPPES registry on July 1, 2006.

Where is Southeastern Dermatology, PA located?

Southeastern Dermatology, PA is located at 2040 Fleischmann Rd, Tallahassee, FL 32308. The listed phone number is (850) 422-3376.

What is Southeastern Dermatology, PA's specialty?

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

Is Southeastern Dermatology, PA enrolled in Medicare?

Yes. Southeastern Dermatology, PA is registered in the Medicare PECOS enrollment system.

When is Southeastern Dermatology, PA's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Florida, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Southeastern Dermatology, PA hold CLIA laboratory certificates?

Yes. 3 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.

What insurance does Southeastern Dermatology, PA accept?

Health plans from Capital Health Plan list Southeastern Dermatology, PA 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 Southeastern Dermatology, PA was last updated on June 14, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.