Bold City Dermatology LLC
NPI 1538761655 · MOHS-Micrographic Surgery Physician · St Augustine, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Bold City Dermatology LLC is a MOHS-Micrographic Surgery Physician organization in St Augustine, FL (NPI 1538761655).
Provider details
- NPI number
- 1538761655
- Entity type
- Organization
- Primary specialty
- MOHS-Micrographic Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Bishr Al Dabagh, Owner(704) 230-1302
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Dermatology Physician207N00000X
Allopathic & Osteopathic Physicians
- Procedural Dermatology Physician207NS0135X
Allopathic & Osteopathic Physicians
- Pediatric Dermatology Physician207NP0225X
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 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
- 2020-11-13
- Last updated
- 2021-01-26
- Certified
- 2021-01-26
Frequently asked questions
- What is Bold City Dermatology LLC's NPI number?
- Bold City Dermatology LLC's National Provider Identifier (NPI) is 1538761655, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Bold City Dermatology LLC?
- Bold City Dermatology LLC is classified in the NPPES registry as MOHS-Micrographic Surgery Physician (Allopathic & Osteopathic Physicians).
- Where is Bold City Dermatology LLC located?
- Bold City Dermatology LLC's practice location on file with NPPES is 316 Paseo Reyes Dr, St Augustine, FL 32095-8464.
- What is Bold City Dermatology LLC's phone number?
- The practice phone number listed in the NPPES registry for Bold City Dermatology LLC is (904) 544-5800.
- Does Bold City Dermatology LLC accept Medicare?
- Bold City 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 Bold City Dermatology LLC?
- The authorized official listed on Bold City Dermatology LLC's NPPES record is Bishr Al Dabagh, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Bold City Dermatology LLC's NPI active?
- Yes — Bold City Dermatology LLC's NPI (1538761655) is active in the NPPES registry as of the last update on 2021-01-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.