Southside Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SOUTHSIDE DERMATOLOGY PLLC

Practice address

3300 S Aspen Ave Ste a
Broken Arrow, OK 74012-7501

Phone

(918) 760-0700

NPI assigned

Mar 28, 2022

Organization subpart

No

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

Authorized official

Name

Alison FischerNPI 1225266307

Title

Owner

Phone

(918) 760-0700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Southside Dermatology PLLC

  • Dermatology Physician
  • Muskogee, OK
  • NPI 1205586500

  O20180802002933

  Same enrollment
• Southside Dermatology PLLC

  • Dermatology Physician
  • Tulsa, OK
  • NPI 1750877072

  O20180802002933

  Same enrollment

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00426

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alison Fischer, M.D.

  • Dermatology Physician
  • Tulsa, OK
  • NPI 1225266307
  NPD Authorized official
• Autum Michole Caldwell, P.A. - C

  • Physician Assistant
  • Tulsa, OK
  • NPI 1396093647
  NPD
• Julie Kaye Curtis, P A C

  • Physician Assistant
  • Tulsa, OK
  • NPI 1912998857
  NPD
• Robert Fischer, MD

  • MOHS-Micrographic Surgery Physician
  • Tulsa, OK
  • NPI 1023378759
  NPD
• Jessica Laura Graves, PA-C

  • Medical Physician Assistant
  • Broken Arrow, OK
  • NPI 1407120066
  NPD
• Kathy Huynh, PA-C

  • Physician Assistant
  • Broken Arrow, OK
  • NPI 1588211361
  NPD
• Michelle Renee Lapidus, P.A.-C

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1962508457
  NPD
• David B Minor, MD

  • Dermatology Physician
  • Tulsa, OK
  • NPI 1285610402
  NPD
• Joe Randall Monroe, PA

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1083613822
  NPD
• Mary Melissa Morgan, M.D.

  • Procedural Dermatology Physician
  • Broken Arrow, OK
  • NPI 1487621413
  NPD
• Debra Sue Odom, P.A.

  • Medical Physician Assistant
  • Tulsa, OK
  • NPI 1316905110
  NPD
• Matthew R Patton, PA

  • Physician Assistant
  • Tulsa, OK
  • NPI 1164758496
  NPD

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1073263380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6966 S UTICA AVE STE 225",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363903",
            "telephone_number": "918-492-6333",
            "fax_number": "918-493-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 S ASPEN AVE STE A",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127501",
            "telephone_number": "918-760-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "FISCHER",
        "authorized_official_first_name": "ALISON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-760-0700"
    },
    "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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• Alessandra Soto
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• Southlake Dialysis LLC
• Sandra Souvannachak, PHARMD
• Karen Sparks
• Lindsay R Sparks, PTA
• Rickey Joe Sparks, PHD
• Matthew Dylan Spears, MSPT

• Dermatology Physician in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.