NPIMap

Organization Active NPI

Iowa Dermatology Clinic, PLC

Doing business as Radiant Complexions Dermatology Clinic

  • Dermatology Physician
  • Urbandale, IA
National Provider Identifier
1083086862
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
IOWA DERMATOLOGY CLINIC, PLC
Doing business as
Radiant Complexions Dermatology Clinic
Practice address
3729 86TH St
Urbandale, IA 50322
Phone
(515) 277-2813
Fax
(515) 277-2814
NPI assigned
Oct 20, 2015
Reactivated
Jun 27, 2018
Last updated
Jul 11, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
IOWA DERMATOLOGY CLINIC, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Authorized official

Name
Dr. Charles Love, M.D.NPI 1043312432
Title
Owner
Phone
(515) 226-8484

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

3729 86TH St
Urbandale, IA 50322

Mailing address

6800 Lake Dr Ste 285
West Des Moines, IA 50266-2544
Phone (515) 277-2813

Other names 1

  • Radiant Complexions Dermatology Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000335 IA Part B Supplier - Clinic/Group Practice 2961394713 Receives reassigned benefits from 25 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshalltown, IA; Cedar Rapids, IA; Mason City, IA; Norwalk, IA; Storm Lake, IA; Urbandale, IA; West Des Moines, IA; Grinnell, IA…

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory
Part of
Iowa Dermatology Clinic PLC

Locations

3729 86th St
Urbandale, IA 50322
Phone (515) 277-2813

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": "1445299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1083086862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 LAKE DR STE 285",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502662544",
            "telephone_number": "515-277-2813",
            "fax_number": "515-277-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3729 86TH ST",
            "city": "URBANDALE",
            "state": "IA",
            "postal_code": "50322",
            "telephone_number": "515-277-2813",
            "fax_number": "515-277-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA DERMATOLOGY CLINIC, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IOWA DERMATOLOGY CLINIC, PLC",
        "enumeration_date": "2015-10-20",
        "last_updated": "2018-07-11",
        "deactivation_date": "2018-03-28",
        "reactivation_date": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "LOVE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-226-8484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Complexions Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Radiant Complexions Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Urbandale, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.