Organization Active NPI

Rochester Skin Cancer Center, P.C.

  • MOHS-Micrographic Surgery Physician
  • Rochester Hills, MI
National Provider Identifier
1053500454
Registry record updated May 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
ROCHESTER SKIN CANCER CENTER, P.C.
Practice address
405 Barclay Cir
Rochester Hills, MI 48307-4573
Phone
(248) 293-0800
NPI assigned
Oct 22, 2007
Last updated
May 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2015

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

Authorized official

Name
Jennifer E McDonald
Title
Business Office Manager
Phone
(248) 293-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X NU Primary

Addresses

Primary practice location

405 Barclay Cir
Rochester Hills, MI 48307-4573

Mailing address

405 Barclay Cir
Rochester Hills, MI 48307-4573
Phone (248) 293-0800

Other identifiers 3

IdentifierTypeStateIssuer
5607758OtherMIAETNA
070F322730OtherMIBLUE CROSS BLUE SHIELD
DB75711OtherMIRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040716000442 MI Part B Supplier - Clinic/Group Practice 0941289581 Receives reassigned benefits from 1 practitioner
Practice locations: Rochester Hills, MI

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
23D0986830Rochester Skin Cancer Center405 Barclay Circle, Rochester Hills, MI 48307ComplianceAug 24, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IAJHCD

Practitioners & affiliated clinicians

Practitioners 1

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": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431388800000",
    "number": "1053500454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 BARCLAY CIR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074573",
            "telephone_number": "248-293-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BARCLAY CIR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074573",
            "telephone_number": "248-293-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCHESTER SKIN CANCER CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2015-05-12",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "248-293-0800"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5607758",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "070F322730",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB75711",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; 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.