State Wide Dermatology LLC
NPI 1427473073 · Dermatology Physician · Odessa, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
State Wide Dermatology LLC is a Dermatology Physician organization in Odessa, FL (NPI 1427473073).
Provider details
- NPI number
- 1427473073
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kathleen Harrell, Owner(813) 749-6907
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2014-02-19
- Last updated
- 2014-07-28
Frequently asked questions
- What is State Wide Dermatology LLC's NPI number?
- State Wide Dermatology LLC's National Provider Identifier (NPI) is 1427473073, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is State Wide Dermatology LLC?
- State Wide Dermatology LLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is State Wide Dermatology LLC located?
- State Wide Dermatology LLC's practice location on file with NPPES is 17121 Rainbow Ter, Odessa, FL 33556-2107.
- What is State Wide Dermatology LLC's phone number?
- The practice phone number listed in the NPPES registry for State Wide Dermatology LLC is (813) 749-6907.
- Does State Wide Dermatology LLC accept Medicare?
- State Wide Dermatology LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for State Wide Dermatology LLC?
- The authorized official listed on State Wide Dermatology LLC's NPPES record is Kathleen Harrell, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is State Wide Dermatology LLC's NPI active?
- Yes — State Wide Dermatology LLC's NPI (1427473073) is active in the NPPES registry as of the last update on 2014-07-28.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.