NPIMap

Organization Active NPI

Dermatology Inc

  • Dermatology Physician
  • Greenwood, IN
National Provider Identifier
1053421610
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY INC
Practice address
875 Airport Pkwy
Greenwood, IN 46143-1085
Phone
(317) 926-3739
Fax
(317) 921-7478
NPI assigned
Aug 30, 2006
Reactivated
Sep 22, 2022
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Authorized official

Name
Khristi Autajay
Title
Practice Administrator
Phone
(317) 926-3739

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

875 Airport Pkwy
Greenwood, IN 46143-1085

Mailing address

875 Airport Pkwy
Greenwood, IN 46143-1085
Phone (317) 926-3739

Other practice location 1

1542 S Bloomington St Fl 3
Greencastle, IN 46135-2212
Phone (317) 926-3739

Other practice location 2

13250 Hazel Dell Pkwy Ste 102
Carmel, IN 46033
Phone (317) 926-3739

Other practice location 3

725 Lakefront Ct
Carmel, IN 46032-5893
Phone (317) 926-3739

Other identifiers 1

IdentifierTypeStateIssuer
100056130 AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050504001196 IN Part B Supplier - Clinic/Group Practice 4587604962 Receives reassigned benefits from 21 practitioners
Practice locations: Tipton, IN; Shelbyville, IN; Fishers, IN; New Castle, IN; Lebanon, IN; Greenwood, IN; Greencastle, IN; Carmel, IN…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
15D1040036Dermatology, Inc875 Airport Parkway, Greenwood, IN 46143ComplianceDec 30, 2027
15D2191794Dermatology, Inc13250 Hazel Dell Parkway Suite 100, Carmel, IN 46033Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Locations

13250 Hazel Dell Pkwy
Ste 100
Carmel, IN 46033
Phone 31792637395155

13250 Hazel Dell Pkwy
Ste 102
Carmel, IN 46033
Phone (317) 818-8166

725 Lakefront Ct
Carmel, IN 46032
Phone (317) 426-3739

1542 S Bloomington St
Ste 1200
Greencastle, IN 46135

1801 Senate Blvd
Ste 745
Indianapolis, IN 46202
Phone (317) 962-5600

2505 N Lebanon St
Ste 200
Lebanon, IN 46052
Phone (765) 482-0656

2705 N Lebanon St
Ste 360
Lebanon, IN 46052
Phone (317) 428-5044

1722 S Memorial Dr
Ste F
New Castle, IN 47362

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1053421610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 AIRPORT PKWY",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431085",
            "telephone_number": "317-926-3739",
            "fax_number": "317-921-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 AIRPORT PKWY",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431085",
            "telephone_number": "317-926-3739",
            "fax_number": "317-921-7478"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1542 S Bloomington St Fl 3",
            "address_purpose": "LOCATION",
            "city": "Greencastle",
            "state": "IN",
            "postal_code": "461352212",
            "country_code": "US",
            "telephone_number": "317-926-3739",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13250 Hazel Dell Pkwy Ste 102",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "46033",
            "country_code": "US",
            "telephone_number": "317-926-3739",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "725 Lakefront Ct",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "460325893",
            "country_code": "US",
            "telephone_number": "317-926-3739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "deactivation_date": "2022-08-19",
        "reactivation_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "AUTAJAY",
        "authorized_official_first_name": "KHRISTI",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "317-926-3739"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100056130  A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.