NPIMap

Organization Active NPI

Azeal Dermatology Institute, LLC

  • Dermatology Physician
  • Boulder, CO
National Provider Identifier
1003209248
Registry record updated Sep 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
AZEAL DERMATOLOGY INSTITUTE, LLC
Practice address
5365 Spine Rd
Suite C
Boulder, CO 80301-3324
Phone
(303) 530-9325
NPI assigned
Mar 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacey Pilkington, D.O.NPI 1215217096
Title
Owner
Phone
(303) 530-9325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

5365 Spine Rd
Suite C
Boulder, CO 80301-3324

Mailing address

PO Box 7446
Loveland, CO 80537-0446
Phone (970) 663-2742

Other identifiers 1

IdentifierTypeStateIssuer
77885376MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150610000752 CO Part B Supplier - Clinic/Group Practice 6204157621 Receives reassigned benefits from 2 practitioners
Practice locations: Boulder, CO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1003209248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7446",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370446",
            "telephone_number": "970-663-2742",
            "fax_number": "970-667-0847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5365 SPINE RD",
            "address_2": "SUITE C",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803013324",
            "telephone_number": "303-530-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZEAL DERMATOLOGY INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-12",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "PILKINGTON",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-530-9325",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77885376",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.