John Gregory Neily (NPI# 1760553630, PAC ID# 3375624554) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1760553630 |
| PAC ID by PECOS | 3375624554 |
| Professional Enrollment ID | I20101111000232 |
| Full Name | John Gregory Neily |
| Organization Legal Name | WATERS EDGE DERMATOLOGY LLC |
| Address |
4315 Tamiami Trl S Venice FL 34293-5117 |
| Phone Number | 9412185300 |
| Gender | M |
| Medical School | SOUTHEASTERN COLLEGE OF OSTEO MEDICINE |
| Graduation Year | 1989 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 6901893155 |
| Number of Group Practice Members | 68 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 100070 | VENICE REGIONAL BAYFRONT HEALTH |
| Address | Phone | Organization |
|---|---|---|
| 21550 Angela Ln, Venice, FL 34293-2017 | 9414937400403 | COAST DERMATOLOGY AND SKIN CANCER CENTER PA |
| 4315 Tamiami Trl S, Venice, FL 34293-5117 | 9412185300 | WATERS EDGE DERMATOLOGY LLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_1 | Immunization Registry Reporting | % | |
| ACI_EC_TRANS_PHCDRR_3 | Specialized Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| MIPS_EC_137_overall | Melanoma: Continuity of Care - Recall System | 96% | |
| MIPS_EC_224_overall | Melanoma: Overutilization of Imaging Studies in Melanoma | 99% | |
| MIPS_EC_337_overall | Tuberculosis (TB) Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier | 83% | |
| MIPS_EC_402_overall | Tobacco Use and Help with Quitting Among Adolescents | 100% | |
| MIPS_EC_431_overall | Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling | 95% |
| Organization Legal Name | WATERS EDGE DERMATOLOGY LLC |
| Physicians | 65 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jonathan M Carp | Dermatology | Waters Edge Dermatology LLC | 6642 W Atlantic Ave, Delray Beach, FL 33446-1616 |
| Stefan Doig | Dermatology | Waters Edge Dermatology LLC | 2910 Se3rd Ct, Ocala, FL 34471-0485 |
| Christopher Spock | Dermatology | Waters Edge Dermatology LLC | 121 S State Rd, Suite 7, Wellington, FL 33414-4338 |
| Gioconda A Boaz | Physician Assistant | Waters Edge Dermatology LLC | 2685 Forest Hill Blvd, West Palm Beach, FL 33406-5930 |
| Claudia Alejandra Vera | Physician Assistant | Waters Edge Dermatology LLC | 562 N Us Hwy 27, Lady Lake, FL 32159-3776 |
| Shery M Varghese | Dermatology | Waters Edge Dermatology LLC | 590 Malabar Rd Se, Suite 2, Palm Bay, FL 32907-3108 |
| Michael T Siino | Physician Assistant | Waters Edge Dermatology LLC | 7605 Conroy Windermere Rd, Orlando, FL 32835-2646 |
| Laura B Destefano | Dermatology | Waters Edge Dermatology LLC | 2484 Caring Way, Unit C, Port Charlotte, FL 33952-5306 |
| Theodore A Schiff | Dermatology | Waters Edge Dermatology LLC | 600 Village Square Xing, Palm Beach Gardens, FL 33410-4543 |
| Jodie Schmidt | Nurse Practitioner | Waters Edge Dermatology LLC | 22411 Hwy 27, Lake Wales, FL 33859-6861 |
| Street Address |
4315 TAMIAMI TRL S |
| City | VENICE |
| State | FL |
| Zip | 34293-5117 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Faith Mccormack | Physical Therapy | Rick Haupt Physical Therapy Inc | 1776 S Tamiami Trail, Venice, FL 34293 |
| James V Theriault | Chiropractic | 1846 S Tamiami Trial, Unit 101, Venice, FL 34293 | |
| Suzanna L Vass | Emergency Medicine | 621 W Michigan Dr, Venice, FL 34293-1230 | |
| David B Macmillan | Family Medicine | Senior Friendship Centers Inc | 2350 Scenic Dr, Venice, FL 34293-1510 |
| Richard Perry Tibbils | Qualified Audiologist | Senior Friendship Centers Inc | 2350 Scenic Dr, Venice, FL 34293-1510 |
| Michael B Mcbride | Family Medicine | Senior Friendship Centers Inc | 2350 Scenic Dr, Venice, FL 34293-1510 |
| Bette E Boysen | Family Medicine | Senior Friendship Centers Inc | 2350 Scenic Dr, Venice, FL 34293-1510 |
| David R Fawks | Nurse Practitioner | Senior Friendship Centers Inc | 2350 Scenic Dr, Venice, FL 34293-1510 |
| Robert J Dobrzynski | Urology | Senior Friendship Centers Inc | 2350 Scenic Dr, Venice, FL 34293-1510 |
| Marvin Gary Frank | Ophthalmology | Senior Friendship Centers Inc | 2350 Scenic Dr, Venice, FL 34293-1510 |
| Find all physicians in zip 34293 | |||
| City | VENICE |
| Zip Code | 34293 |
| Specialty | DERMATOLOGY |
| City + Specialty | VENICE + DERMATOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.