{
  "npi": "1184291106",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "NICOLE",
    "authorized_official_last_name": "PROFFITT",
    "authorized_official_telephone_number": "8048696269",
    "authorized_official_title_or_position": "Director of Enrollment & Credential",
    "certification_date": "2026-09-14",
    "enumeration_date": "2021-06-08",
    "last_updated": "2026-09-14",
    "organization_name": "ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 23329",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "NEW YORK",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "410-883-0876",
      "postal_code": "100873329",
      "state": "NY"
    },
    {
      "address_1": "3950 3RD ST N STE A",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "ST PETERSBURG",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "727-822-5507",
      "postal_code": "337036123",
      "state": "FL",
      "telephone_number": "727-821-0612"
    }
  ],
  "taxonomies": [
    {
      "code": "207N00000X",
      "desc": "Dermatology",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "207ND0101X",
      "desc": "Dermatology, MOHS-Micrographic Surgery",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "207NP0225X",
      "desc": "Dermatology, Pediatric Dermatology",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "207NS0135X",
      "desc": "Dermatology, Procedural Dermatology",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)",
    "certifying_board": "American Board of Dermatology (ABD)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "07",
        "medicare_type": "Physician/Dermatology"
      }
    ]
  }
}