NPIMap

Organization Active NPI

Skin PC

Doing business as Skin Dermatology & Aesthetics

  • Dermatology Physician
  • Elkhorn, NE
National Provider Identifier
1134410764
Registry record updated Apr 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SKIN PC
Doing business as
Skin Dermatology & Aesthetics
Practice address
1408 Veterans Dr
Suite 100
Elkhorn, NE 68022-6912
Phone
(402) 916-5664
NPI assigned
Apr 30, 2011
Last updated
Apr 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2011

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

Authorized official

Name
Mr. Chad M Hillyer, PA-CNPI 1902825904
Title
Owner
Phone
(402) 916-5664

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1408 Veterans Dr
Suite 100
Elkhorn, NE 68022-6912

Mailing address

1408 Veterans Dr
Suite 100
Elkhorn, NE 68022-6912
Phone (402) 916-5664

Other names 1

  • Skin Dermatology & Aesthetics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110614000400 NE Part B Supplier - Clinic/Group Practice 4486831740 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Fremont, NE; Elkhorn, NE

Other NPIs on the same Medicare enrollment 1

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

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
28D2098084Skin PC Dermatology1408 Veterans Drive Suite 100, Elkhorn, NE 68022Provider-performed microscopyJun 29, 2027

National Provider Directory

National Provider Directory

Locations

1408 Veterans Dr
Elkhorn, NE 68022
Phone (402) 885-0344

1408 Veterans Dr
Ste 100
Elkhorn, NE 68022
Phone (402) 916-5664

410 E 22nd St
Ste 101
Fremont, NE 68025

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": "1304121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304121600000",
    "number": "1134410764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 VETERANS DR",
            "address_2": "SUITE 100",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680226912",
            "telephone_number": "402-916-5664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 VETERANS DR",
            "address_2": "SUITE 100",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680226912",
            "telephone_number": "402-916-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-30",
        "last_updated": "2011-04-30",
        "status": "A",
        "authorized_official_last_name": "HILLYER",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-916-5664",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skin Dermatology & Aesthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhorn, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2011; 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.