NPIMap

Organization Active NPI

Rochester Dermatology Clinic, P.C.

  • Dermatology Physician
  • Rochester Hills, MI
National Provider Identifier
1114192754
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
5101005759 Issued in MI
Legal business name
ROCHESTER DERMATOLOGY CLINIC, P.C.
Practice address
405 Barclay Cir
Rochester Hills, MI 48307-4573
Phone
(248) 843-3131
Fax
(248) 853-3275
NPI assigned
Apr 24, 2008
Last updated
Apr 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Dr. Roger Clarence Byrd, D.O.
Title
President
Phone
(248) 853-3131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 5101005759 MI Primary

Addresses

Primary practice location

405 Barclay Cir
Rochester Hills, MI 48307-4573

Mailing address

56853 Mount Vernon Rd
Shelby TWP, MI 48316-4829
Phone (248) 652-3926

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080522000708 MI Part B Supplier - Clinic/Group Practice 8628147154 Receives reassigned benefits from 3 practitioners
Practice locations: Rochester, MI; Rochester Hills, MI; Troy, MI

National Provider Directory

National Provider Directory

Locations

405 Barclay Cir
Ste 104
Rochester Hills, MI 48307
Phone (248) 293-0800

Practitioners & affiliated clinicians

Practitioners 4

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": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1114192754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56853 MOUNT VERNON RD",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483164829",
            "telephone_number": "248-652-3926",
            "fax_number": "248-853-3275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BARCLAY CIR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074573",
            "telephone_number": "248-843-3131",
            "fax_number": "248-853-3275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCHESTER DERMATOLOGY CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "BYRD",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "CLARENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-853-3131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101005759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.