NPIMap

Organization Active NPI

Dermatology Center of Indiana PC

  • Dermatology Physician
  • Plainfield, IN
National Provider Identifier
1033199138
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
01051020A Issued in IN
Legal business name
DERMATOLOGY CENTER OF INDIANA PC
Practice address
1100 Southfield Dr Ste 1240
Plainfield, IN 46168-4499
Phone
(317) 838-9911
Fax
(317) 837-6080
NPI assigned
Jan 17, 2006
Last updated
Jun 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Authorized official

Name
Scott Thomas Guenthner, M.D.NPI 1396748778
Title
President
Phone
(317) 838-9911

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
Dermatology Physician 207N00000X 01051020A IN Primary

Addresses

Primary practice location

1100 Southfield Dr Ste 1240
Plainfield, IN 46168-4499

Mailing address

111 New Hampshire Ave Ste 2
Portsmouth, NH 03801-2864
Phone (802) 909-2053

Other identifiers 3

IdentifierTypeStateIssuer
200417550AMedicaidIN
070017306OtherINRAILROAD MEDICARE
7430356OtherINAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080401000053 IN Part B Supplier - Clinic/Group Practice 0941386999 Receives reassigned benefits from 12 practitioners
Practice locations: Greenwood, IN; Zionsville, IN; Plainfield, IN; Bloomington, IN

National Provider Directory

National Provider Directory

Locations

824 Edwards Dr
Ste 172
Plainfield, IN 46168
Phone (317) 406-3254

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1033199138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NEW HAMPSHIRE AVE STE 2",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038012864",
            "telephone_number": "802-909-2053",
            "fax_number": "330-965-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SOUTHFIELD DR STE 1240",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461684499",
            "telephone_number": "317-838-9911",
            "fax_number": "317-837-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER OF INDIANA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-17",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "GUENTHNER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-838-9911",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01051020A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200417550A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070017306",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7430356",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.