NPIMap

Organization Active NPI

Dermatology Office PC

Doing business as Elite Dermatology

  • Dermatology Physician
  • Poplar Bluff, MO
National Provider Identifier
1043462591
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY OFFICE PC
Doing business as
Elite Dermatology
Practice address
1600 W Harper St
Poplar Bluff, MO 63901-4119
Phone
(573) 686-4750
Fax
(573) 686-4753
NPI assigned
Oct 15, 2008
Last updated
Sep 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

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

Authorized official

Name
Brenda Hughes
Title
Office Manger
Phone
(573) 686-4750

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X

Addresses

Primary practice location

1600 W Harper St
Poplar Bluff, MO 63901-4119

Mailing address

1600 W Harper St
Poplar Bluff, MO 63901-4119
Phone (573) 686-4750

Other names 1

  • Elite Dermatology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090105000113 MO Part B Supplier - Clinic/Group Practice 0244392009 Receives reassigned benefits from 6 practitioners
Practice locations: Poplar Bluff, MO
O20131202000527 AR Part B Supplier - Clinic/Group Practice 0244392009 Receives reassigned benefits from 2 practitioners
Practice locations: Paragould, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1098352Dermatology Office1600 W Harper, Poplar Bluff, MO 63901Certificate of waiverSep 26, 2026

National Provider Directory

National Provider Directory

Locations

2711 W Kingshighway
Paragould, AR 72450
Phone (870) 215-0669

225 Physicians Park
Ste 203
Poplar Bluff, MO 63901
Phone (573) 686-4750

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789948800000",
    "number": "1043462591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W HARPER ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014119",
            "telephone_number": "573-686-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W HARPER ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014119",
            "telephone_number": "573-686-4750",
            "fax_number": "573-686-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY OFFICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-15",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "573-686-4750"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; 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.

Verify at the official NPI Registry.