Organization Active NPI

South Hills Dermatology PC

  • Dermatology Physician
  • Pittsburgh, PA
National Provider Identifier
1104843275
Registry record updated Nov 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD045711L Issued in PA
Legal business name
SOUTH HILLS DERMATOLOGY PC
Practice address
363 Vanadium Rd
Suite 101
Pittsburgh, PA 15243
Phone
(412) 279-6799
Fax
(412) 279-6722
NPI assigned
Jul 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2012

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

Authorized official

Name
Dr. Carol L Neish, MDNPI 1356307987
Title
President
Phone
(412) 279-6799

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)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X MD045711L PA Primary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X MD0538284 PA

Addresses

Primary practice location

363 Vanadium Rd
Suite 101
Pittsburgh, PA 15243

Mailing address

363 Vanadium Rd
Suite 101
Pittsburgh, PA 15243
Phone (412) 279-6799

Other identifiers 3

IdentifierTypeStateIssuer
1760671OtherBCBS
1084397OtherAETNA
7020736OtherAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050921000951 PA Part B Supplier - Clinic/Group Practice 9830123678 Receives reassigned benefits from 4 practitioners
Practice locations: McMurray, PA; Pittsburgh, PA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D1044227South Hills Dermatology PC363 Vanadium Road, Pittsburgh, PA 15243Provider-performed microscopyOct 17, 2027

National Provider Directory

National Provider Directory

Locations

2001 Waterdam Plaza Dr
Ste 100
Canonsburg, PA 15317

2001 Waterdam Plaza Dr
Ste 101
McMurray, PA 15317
Phone (412) 262-1064

363 Vanadium Rd
Ste 101
Pittsburgh, PA 15243
Phone (412) 279-6799

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353369600000",
    "number": "1104843275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 VANADIUM RD",
            "address_2": "SUITE 101",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "15243",
            "telephone_number": "412-279-6799",
            "fax_number": "412-279-6722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 VANADIUM RD",
            "address_2": "SUITE 101",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "15243",
            "telephone_number": "412-279-6799",
            "fax_number": "412-279-6722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HILLS DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2012-11-20",
        "status": "A",
        "authorized_official_last_name": "NEISH",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "412-279-6799",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD045711L",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD0538284",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1760671",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1084397",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7020736",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.