NPIMap

Organization Active NPI

Advanced Dermatology of North Central Ohio Inc

  • Procedural Dermatology Physician
  • Mansfield, OH
National Provider Identifier
1073528733
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
35063717T Issued in OH
Legal business name
ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC
Doing business as
Advanced Dermatology of North Central Ohio Inc
Practice address
770 Balgreen Dr
Ste 201
Mansfield, OH 44906-4106
Phone
(419) 756-1600
Fax
(419) 775-1196
NPI assigned
Jul 30, 2006
Last updated
Aug 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

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

Authorized official

Name
Dr. Christ John Ticoras, M.D.NPI 1821099615
Title
Owner/President
Phone
(419) 756-1600

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X
Procedural Dermatology Physician 207NS0135X
Procedural Dermatology Physician 207NS0135X 35063717T OH Primary

Addresses

Primary practice location

770 Balgreen Dr
Ste 201
Mansfield, OH 44906-4106

Mailing address

PO Box 735056
Dallas, TX 75373-5056
Phone (419) 756-1600

Other identifiers 1

IdentifierTypeStateIssuer
2251316MedicaidOH

Other names 1

  • ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100624000226 OH Part B Supplier - Clinic/Group Practice 7113058801 Receives reassigned benefits from 16 practitioners
Practice locations: Bidwell, OH; Centerville, OH; Mansfield, OH

National Provider Directory

National Provider Directory

Locations

770 Balgreen Dr
Ste 201
Mansfield, OH 44906
Phone (419) 756-1600

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1073528733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735056",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753735056",
            "telephone_number": "419-756-1600",
            "fax_number": "419-775-1196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 BALGREEN DR",
            "address_2": "STE 201",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449064106",
            "telephone_number": "419-756-1600",
            "fax_number": "419-775-1196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "TICORAS",
        "authorized_official_first_name": "CHRIST",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "419-756-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OH",
            "license": "35063717T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2251316",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; 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.