Premier Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PREMIER DERMATOLOGY, PLLC

Practice address

6240 S Main St
Aurora, CO 80016-5376

Phone

(303) 908-1673

NPI assigned

Sep 9, 2021

Last updated

Sep 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Agnessa Goodson, MDNPI 1295025682

Title

MD/Dermatologist and Manager

Phone

(303) 908-1673

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Agnessa Gadeliya Goodson, M.D.

  • Dermatology Physician
  • Aurora, CO
  • NPI 1295025682
  Medicare reassignment Care Compare group NPD Authorized official
• Megan Thackaberry Holleman, PA-C

  • Physician Assistant
  • Aurora, CO
  • NPI 1659076859
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1023787371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7867 S CATHAY ST",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "800161941",
            "telephone_number": "303-908-1673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6240 S MAIN ST",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800165376",
            "telephone_number": "303-908-1673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "GOODSON",
        "authorized_official_first_name": "AGNESSA",
        "authorized_official_title_or_position": "MD/DERMATOLOGIST AND MANAGER",
        "authorized_official_telephone_number": "303-908-1673",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sarah Haily Pregmon, LPC
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• Cody Lloyd Prentice, PA
• Christa Jillian Prentiss, MD
• Deborah Presken
• Cheryl Lyn Presley, RN

• Dermatology Physician in Aurora, CO
• Providers in Aurora, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; 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.