Active NPI
Advanced Dermcare PC
- Dermatology Physician
- Danbury, CT
National Provider Identifier
1023068087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- ADVANCED DERMCARE PC
- Practice address
- 25 Tamarack Ave
Advanced Derm Care PC
Danbury, CT 06811 - Phone
- (203) 797-8990
- Fax
- (203) 748-7861
- NPI assigned
- May 11, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Diane Edmond
- Title
- Credentialing
- Phone
- (203) 731-2207
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
25 Tamarack Ave
Advanced Derm Care PC
Danbury, CT 06811
Mailing address
25 Tamarack Ave
Danbury, CT 06811-4829
Phone (203) 797-8990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004395390 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040831000383 | CT | Part B Supplier - Clinic/Group Practice | 8628043924 |
Receives reassigned benefits from 13 practitioners Practice locations: Danbury, CT; Southbury, CT; Waterbury, CT; Weston, CT |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D0100947 | Advanced Dermcare PC | Compliance | Apr 18, 2028 |
National Provider Directory
National Provider DirectoryLocations
25 Tamarack Ave
Danbury, CT 06811
Phone (203) 797-8990
38B Grove St
Ste 2A
Ridgefield, CT 06877
760 Main St S
Southbury, CT 06488
Phone (203) 267-3880
760 Main St S
Ste C-2
Southbury, CT 06488
Phone (203) 797-8990
1389 W Main St
Ste 322
Waterbury, CT 06708
Phone (203) 753-0877
Practitioners & affiliated clinicians
Practitioners 14
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": "1147305600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1709683200000",
"number": "1023068087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 TAMARACK AVE",
"city": "DANBURY",
"state": "CT",
"postal_code": "068114829",
"telephone_number": "203-797-8990",
"fax_number": "203-748-7861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 TAMARACK AVE",
"address_2": "ADVANCED DERM CARE PC",
"city": "DANBURY",
"state": "CT",
"postal_code": "06811",
"telephone_number": "203-797-8990",
"fax_number": "203-748-7861"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED DERMCARE PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-11",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A",
"authorized_official_last_name": "EDMOND",
"authorized_official_first_name": "DIANE",
"authorized_official_title_or_position": "CREDENTIALING",
"authorized_official_telephone_number": "203-731-2207",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004395390",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danbury, CT
- Adult Home Care, LLC
- Advanced Audiology & Hearing Aid Services
- Advanced Center for Foot Medicine and Surgery LLC
- Advanced Center for Foot Medicine and Surgery,LLC
- Advanced Chiropractic Wellness Care-Danbury P.L.L.C
- Advanced Orthotics and Prosthetics Technologies LLC
- Advanced Specialty Care, P.C.
- Afc Physicians of Connecticut, PC
- Afc Physicians of Connecticut, PC
- Afc Physicians of Connecticut, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.