Active NPI
Near Me Dermatology PLLC
- Dermatology Physician
- West Seneca, NY
National Provider Identifier
1083387898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- NEAR ME DERMATOLOGY PLLC
- Practice address
- 550 Orchard Park Rd Ste A110
West Seneca, NY 14224-2646 - Phone
- (716) 650-5720
- Fax
- (716) 650-4618
- NPI assigned
- Jul 28, 2021
- Last updated
- May 1, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Youn Jea Kim, FNP
- Title
- Chairman of the Boad
- Phone
- (213) 880-2538
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | |||
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
550 Orchard Park Rd Ste A110
West Seneca, NY 14224-2646
Mailing address
1170 Maple Rd
Williamsville, NY 14221-3440
Phone (213) 880-2538
Other practice location 1
609 Central Ave
Dunkirk, NY 14048-2538
Phone (213) 880-2538
Other practice location 2
1170 Maple Rd
Williamsville, NY 14221-3440
Phone (213) 880-2538
Other practice location 3
112 W Main St
Allegany, NY 14706-1204
Phone (716) 650-5720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04401649 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220125000410 | NY | Part B Supplier - Clinic/Group Practice | 5799177747 |
Receives reassigned benefits from 9 practitioners 1 other NPI on this enrollment Practice locations: Buffalo, NY; Dunkirk, NY; West Seneca, NY |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
5210 Linton Blvd
Ste 307
Delray Beach, FL 33484
Phone (561) 499-0660
112 W Main St
Allegany, NY 14706
Phone (716) 373-0700
Practitioners & affiliated clinicians
Practitioners 10
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.
-
- Family Nurse Practitioner
- Geneseo, NY
- NPI 1316629843
-
- Family Nurse Practitioner
- West Seneca, NY
- NPI 1093669293
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627430400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1714521600000",
"number": "1083387898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1170 MAPLE RD",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142213440",
"telephone_number": "213-880-2538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 ORCHARD PARK RD STE A110",
"city": "WEST SENECA",
"state": "NY",
"postal_code": "142242646",
"telephone_number": "716-650-5720",
"fax_number": "716-650-4618"
}
],
"practiceLocations": [
{
"address_1": "609 Central Ave",
"address_purpose": "LOCATION",
"city": "Dunkirk",
"state": "NY",
"postal_code": "140482538",
"country_code": "US",
"telephone_number": "213-880-2538",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1170 Maple Rd",
"address_purpose": "LOCATION",
"city": "Williamsville",
"state": "NY",
"postal_code": "142213440",
"country_code": "US",
"telephone_number": "213-880-2538",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "112 W Main St",
"address_purpose": "LOCATION",
"city": "Allegany",
"state": "NY",
"postal_code": "147061204",
"country_code": "US",
"telephone_number": "716-650-5720",
"fax_number": "716-650-4618",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "NEAR ME DERMATOLOGY PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-07-28",
"last_updated": "2024-05-01",
"certification_date": "2024-05-01",
"status": "A",
"authorized_official_last_name": "KIM",
"authorized_official_first_name": "YOUN JEA",
"authorized_official_title_or_position": "CHAIRMAN OF THE BOAD",
"authorized_official_telephone_number": "213-880-2538",
"authorized_official_credential": "FNP"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04401649",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Seneca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.