Clinzo P. Mickle II, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD036757 Issued in DC

Practice address

650 Pennsylvania Ave SE
Suite 420
Washington, DC 20003-4318

Phone

(202) 547-9001

NPI assigned

Mar 4, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Medical University of South Carolina College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Dermatology of 19TH Street LLCGroup PAC ID 2567626567, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrated Dermatology of 19TH Street LLC

  • Dermatology Physician
  • Washington, DC
  • NPI 1801166467
  Medicare reassignment Care Compare group NPD
• Skincare Physicians St Elizabeths Inc

  • Dermatology Physician
  • Chestnut Hill, MA
  • NPI 1639499676
  NPD (past)
• Skincarephysicians

  • Dermatology Physician
  • Chestnut Hill, MA
  • NPI 1699005173
  NPD (past)

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302048000000",
    "number": "1104096361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 16TH ST NW",
            "address_2": "APT. 243",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200096646",
            "telephone_number": "202-332-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 PENNSYLVANIA AVE SE",
            "address_2": "SUITE 420",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200034318",
            "telephone_number": "202-547-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKLE",
        "first_name": "CLINZO",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-04",
        "last_updated": "2011-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "DC",
            "license": "MD036757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynette Mickel
• Tarik Mickel
• Lavonda K Mickens, PHD
• Mary E Micker, PNP
• Robert W Mickey, MD
• Nina Killie Mickle, MS, RD
• James Joseph Mickler, MD
• Gregory A Mickles
• Mid Atlantic Medicine LLC
• Mid Atlantic Optical Supplies and Consultants LLC

• Dermatology Physician in Washington, DC
• Providers in Washington, DC by specialty
• Dermatology Physician in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.