Advanced Dermatologic Surgery, P.a.
Organization Active NPI MOHS-Micrographic Surgery Physician · Overland Park, KS
NPI 1003016312 · NPPES record last updated Jun 3, 2022
Key facts
- NPI
- 1003016312
- Entity type
- Organization (NPI type 2)
- Primary specialty
- MOHS-Micrographic Surgery Physician 207ND0101X
- Legal business name
- ADVANCED DERMATOLOGIC SURGERY, P.A.
- Practice address
- 6901 W 121St St
Overland Park, KS 66209-2007 - Phone
- (913) 661-1755
- Fax
- (913) 661-9260
- NPI assigned
- Jul 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Greg Albers, MPA
- Title
- Cfo
- Phone
- (913) 661-1755
Practitioners 5
-
Carson Tyler Williams, M.D.
-
Richard Bottoms, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0890923 | Advanced Dermatologic Surgery | Compliance | Nov 27, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS, MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040810000666 | KS | Part B Supplier - Clinic/Group Practice | 1153393194 |
Receives reassigned benefits from 5 practitioners Practice locations: Overland Park, KS |
| O20220708001939 | MO | Part B Supplier - Clinic/Group Practice | 1153393194 |
Receives reassigned benefits from 2 practitioners Practice locations: Kansas City, MO |
National Provider Directory
Locations
6901 W 121st St
Overland Park, KS 66209
Phone (913) 661-1755
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BHJIBA
- thomas.hocker@advderm.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 04-25136 | KS | |
| MOHS-Micrographic Surgery Physician |
207ND0101X | Yes | ||
| Clinical Medical Laboratory | 291U00000X | 04-25136 | KS |
Addresses
Primary practice location
6901 W 121St St
Overland Park, KS 66209-2007
Mailing address
6901 W 121St St
Overland Park, KS 66209-2007
Phone (913) 661-1755
Other practice location 1
6410 N Cosby Ave
Kansas City, MO 64151-2377
Phone (816) 643-4501
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17D0890923 | Other | CLIA # |
Other names
- Advanced Dermatologic Surgery
- Trinity Dermatology
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | thomas.hocker@advderm.eclinicaldirectplus.com | Direct |
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All providers in Overland Park, KS · MOHS-Micrographic Surgery Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.