NPIMap

Organization Active NPI

Central Ohio Skin & Cancer Inc

  • Dermatology Physician
  • Sunbury, OH
National Provider Identifier
1083622930
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CENTRAL OHIO SKIN & CANCER INC
Practice address
100 Tippett Court
Sunbury, OH 43074
Phone
(614) 898-7546
Fax
(614) 794-4294
NPI assigned
Aug 4, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jess J Demaria, MDNPI 1154373009
Title
Vice President
Phone
(614) 898-7546

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

100 Tippett Court
Sunbury, OH 43074

Mailing address

660 Cooper Rd
Ste 400
Westerville, OH 43081
Phone (614) 898-7546

Other identifiers 2

IdentifierTypeStateIssuer
2070342MedicaidOH
CN6982OtherRR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050927000501 OH Part B Supplier - Clinic/Group Practice 4688608870 Receives reassigned benefits from 14 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Powell, OH; Westerville, OH

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

600 N Pickaway St
Ste 1
Circleville, OH 43113
Phone (614) 759-5060

10212 Sawmill Pkwy
Powell, OH 43065
Phone (614) 898-7546

10330 Sawmill Pkwy
#4
Powell, OH 43065
Phone (614) 898-7546

100 Tippett Ct
Sunbury, OH 43074
Phone (614) 431-1634

300 Polaris Pkwy
Ste 3300
Westerville, OH 43082
Phone (614) 898-7546

660 Cooper Rd
Ste 400
Westerville, OH 43081
Phone (614) 209-1471

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083622930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 COOPER RD",
            "address_2": "STE 400",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "43081",
            "telephone_number": "614-898-7546",
            "fax_number": "614-794-4294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TIPPETT COURT",
            "city": "SUNBURY",
            "state": "OH",
            "postal_code": "43074",
            "telephone_number": "614-898-7546",
            "fax_number": "614-794-4294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OHIO SKIN & CANCER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEMARIA",
        "authorized_official_first_name": "JESS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "614-898-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2070342",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CN6982",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunbury, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.