Dermatology and Mohs Surgery Skin Cancer Center

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY AND MOHS SURGERY SKIN CANCER CENTER

Practice address

110 Business Park Dr Ste C
Branson, MO 65616-7449

Phone

(417) 336-0033

Fax

(417) 239-0127

NPI assigned

May 2, 2022

Organization subpart

No

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

Authorized official

Name

Adrienne Michele Schupbach, MDNPI 1740415777

Title

Owner/Physician

Phone

(309) 533-8899

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 10

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

• Adrienne Schupbach, M.D.

  • Dermatology Physician
  • Bloomington, IL
  • NPI 1740415777

  MO

  Medicare reassignment Care Compare group NPD Authorized official
• Shawn Barrett Jackson, M,D,

  • Anatomic Pathology & Clinical Pathology Physician
  • Springfield, MO
  • NPI 1730258708
  Medicare reassignment Care Compare group NPD
• Douglas Michael Leone, M.D.

  • Dermatology Physician
  • Branson, MO
  • NPI 1255523296
  Medicare reassignment Care Compare group NPD
• Rosa Phuongchi Nguyen, FNP

  • Family Nurse Practitioner
  • Springfield, MO
  • NPI 1437405248
  Medicare reassignment Care Compare group NPD
• Micah Griffin, PA-C

  • Physician Assistant
  • Branson, MO
  • NPI 1700427358
  Medicare reassignment Care Compare group
• Ryan Michael Marlett

  • Physician Assistant
  • Branson, MO
  • NPI 1952058992
  Medicare reassignment Care Compare group
• Jason Stubbs

  • Physician Assistant
  • Springfield, MO
  • NPI 1205402351
  Medicare reassignment Care Compare group
• Elyse Verdeyen, PA-C

  • Physician Assistant
  • Branson, MO
  • NPI 1104435163
  Medicare reassignment Care Compare group
• Megan Parsons, PA-C

  • Physician Assistant
  • Joplin, MO
  • NPI 1316652506
  Medicare reassignment
• Cameron Troy Jackson Stengel, PA-C

  • Physician Assistant
  • Pflugerville, TX
  • NPI 1538700851

  MO

  Medicare reassignment

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

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1124763479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BUSINESS PARK DR STE C",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656167449",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BUSINESS PARK DR STE C",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656167449",
            "telephone_number": "417-336-0033",
            "fax_number": "417-239-0127"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 E Cleveland St",
            "address_purpose": "LOCATION",
            "city": "Monett",
            "state": "MO",
            "postal_code": "657086149",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1230 E Kingsley St Ste A",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658047231",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10101 Stoltz Dr",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654017714",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "914 Alexis",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "MO",
            "postal_code": "655366802",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "520 E 32nd St",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648043904",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMATOLOGY AND MOHS SURGERY SKIN CANCER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-02",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "SCHUPBACH",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "309-533-8899",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rick W Davis, OD
• Robert Lee Davis, LCSW
• Wendy Wyone Dawson, PHD, LP
• Dustin Day
• Darla A Denny
• Teena Deronde
• Developmental Connections
• Developmental Connections
• Ricky James Deville II, CRNA
• Brian D Dieterle, M.D.

• Dermatology Physician in Branson, MO
• Providers in Branson, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.