NPIMap

Organization Active NPI

Plymouth Dermatology Associates, PC

  • Dermatology Physician
  • Plymouth, MA
National Provider Identifier
1144362179
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PLYMOUTH DERMATOLOGY ASSOCIATES, PC
Practice address
345 Court St
Suite 201
Plymouth, MA 02360-4329
Phone
(508) 746-5300
Fax
(508) 747-2001
NPI assigned
Feb 13, 2007
Last updated
May 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Authorized official

Name
Dr. Jeffrey N Farber, M.D.NPI 1497774962
Title
Vice President
Phone
(508) 746-5300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

345 Court St
Suite 201
Plymouth, MA 02360-4329

Mailing address

345 Court St
Suite 201
Plymouth, MA 02360-4329
Phone (508) 746-5300

Other identifiers 2

IdentifierTypeStateIssuer
M16586OtherMABLUE CROSS AND BLUE SHIELD
CN6573OtherMARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060220000490 MA Part B Supplier - Clinic/Group Practice 3577578012 Receives reassigned benefits from 11 practitioners
Practice locations: Plymouth, MA

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
22D2263222Plymouth Dermatology Associates, PC345 Court Street, Suite 301, Plymouth, MA 02360ComplianceNov 2, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1144362179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 COURT ST",
            "address_2": "SUITE 201",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023604329",
            "telephone_number": "508-746-5300",
            "fax_number": "508-747-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 COURT ST",
            "address_2": "SUITE 201",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023604329",
            "telephone_number": "508-746-5300",
            "fax_number": "508-747-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH DERMATOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "FARBER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "508-746-5300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD",
            "identifier": "M16586",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN6573",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; 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.