NPIMap

Organization Active NPI

Dermatology and Laser Surgery Center Inc

  • Procedural Dermatology Physician
  • Centerville, OH
National Provider Identifier
1023138492
Registry record updated Feb 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
35043172 Issued in OH
Legal business name
DERMATOLOGY AND LASER SURGERY CENTER INC
Doing business as
DR PALMER
Practice address
6720 Loop Rd
Centerville, OH 45459-2161
Phone
(937) 433-4922
Fax
(937) 433-6520
NPI assigned
Mar 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2013

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

Authorized official

Name
Dr. Gary D Palmer, MDNPI 1134124563
Title
Medical Doctor Pres.
Phone
(937) 433-4922

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X 35043172 OH Primary

Addresses

Primary practice location

6720 Loop Rd
Centerville, OH 45459-2161

Mailing address

6720 Loop Rd
Centerville, OH 45459-2161
Phone (937) 433-4922

Other identifiers 2

IdentifierTypeStateIssuer
402741848001OtherOHMEDICAL MUTUAL PROVIDER
DE181759OtherOHMEDIGAP PROVIDER NUMBER

Other names 1

  • DR PALMER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040419001148 OH Part B Supplier - Clinic/Group Practice 6800881723 Receives reassigned benefits from 1 practitioner
Practice locations: Centerville, OH; Englewood, OH

National Provider Directory

National Provider Directory
Tax ID family
Dermatology Laser Surgery Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361491200000",
    "number": "1023138492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6720 LOOP RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592161",
            "telephone_number": "937-433-4922",
            "fax_number": "937-433-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6720 LOOP RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592161",
            "telephone_number": "937-433-4922",
            "fax_number": "937-433-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND LASER SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2013-02-22",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DOCTOR PRES.",
        "authorized_official_telephone_number": "937-433-4922",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OH",
            "license": "35043172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL PROVIDER",
            "identifier": "402741848001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIGAP PROVIDER NUMBER",
            "identifier": "DE181759",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DR PALMER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; 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.