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LAKESIDE DERMATOLOGY LLC
NPI 1922257260
Dermatology in Sebring, FL

Active since September 11, 2008CLIA 10D2152321 · Certificate of Compliance
727 US 27 S, SEBRING, FL 33870(863) 385-7183(863) 385-0088 Get Directions Write a Review

NPPES record last updated: December 19, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Lakeside Dermatology Llc NPPES

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

LAKESIDE DERMATOLOGY LLC (NPI 1922257260) is a healthcare organization registered as a dermatology in Sebring, Florida and active in the NPI registry since September 2008. The organization holds a CLIA Certificate of Compliance certificate valid through December 9, 2026 and lists Michael Joseph Rogers, Sole Mbr, as its authorized official.

NPPES Registry Identity

NPI1922257260
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameLAKESIDE DERMATOLOGY LLC
Location Address727 US 27 SSebring, FL 33870-2169
Mailing Address727 Us 27 SSebring, FL 33870-2169 · (863) 385-7183 · Fax (863) 385-0088
Phone(863) 385-7183
Fax(863) 385-0088
Organization SubpartNo
Authorized OfficialMichael Joseph RogersSole Mbr · (863) 385-7183
Enumeration DateSeptember 11, 2008
Last NPPES UpdateDecember 19, 2024
NPPES CertifiedDecember 19, 2024
✔ NPI 1922257260 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in FL · ME0058778
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.
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X · License ME0058778 (FL)
727 US 27 S, Sebring, FL 33870
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).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)

Lakeside 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 Lakeside Dermatology LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Alexander Kennon, M.D.
Micrographic Dermatologic Surgery
NPI 1053675868
727 US HIGHWAY 27 S
Sebring, FL 33870
(863) 385-7183
✔ PECOS✔ Accepts MedicareSame address
Michael Rogers
Dermatology
NPI 1003876053
727 US 27 SOUTH
Sebring, FL 33870
(863) 385-7183
✔ PECOS✔ Accepts Medicare3.3 mi
Brooke Rogers, DNP,FNP-C
Nurse Practitioner
NPI 1184038119
727 US HIGHWAY 27 S
Sebring, FL 33870
(863) 385-7183
✔ PECOS✔ Accepts Medicare12 mi
Barbara Ross, NP
Nurse Practitioner
NPI 1457579955
429 2ND ST NW
Winter Haven, FL 33881
(863) 294-7558
✔ PECOS✔ Accepts Medicare41 mi
Erin Atallah, DNP, APRN
Nurse Practitioner
NPI 1639009616
400 AVENUE K SE STE 3
Winter Haven, FL 33880
(863) 293-7546
✔ PECOS✔ Accepts Medicare41 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

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 10D2152321

Lakeside Dermatology · Sebring, FL
Active · expires Dec 9, 2026
CLIA Number10D2152321
Laboratory TypePhysician Office
Certificate Effective DateDecember 10, 2024
Certificate Expiration DateDecember 9, 2026
Laboratory DirectorAlexander W. Kennon
Laboratory Phone(863) 659-4201
Laboratory LocationLakeside Dermatology727 Us Hwy 27 S, Sebring, FL 33870
CLIA data matches this NPI record on: Name
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 Lakeside Dermatology LLC's NPI number?

The NPI number for Lakeside Dermatology LLC is 1922257260. It was assigned to this organization in the NPPES registry on September 11, 2008.

Where is Lakeside Dermatology LLC located?

Lakeside Dermatology LLC is located at 727 Us 27 S, Sebring, FL 33870. The listed phone number is (863) 385-7183.

What is Lakeside Dermatology LLC's specialty?

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

Is Lakeside Dermatology LLC enrolled in Medicare?

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

How many clinicians bill Medicare through Lakeside Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 3 Medicare specialties reassign their Medicare billing to Lakeside 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. The largest specialties are Nurse Practitioner (3), Dermatology (1) and Micrographic Dermatologic Surgery (1). Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Lakeside Dermatology LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 10D2152321) is associated with this NPI, valid through December 9, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lakeside Dermatology LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Lakeside 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 Lakeside Dermatology LLC was last updated on December 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.