Advanced Skin and Mohs Surgery Center S.C.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

036096380 Issued in IL

Legal business name

ADVANCED SKIN AND MOHS SURGERY CENTER S.C.

Practice address

2845 N. Sheridan Road
Ste 912
Chicago, IL 60657

Phone

(773) 281-0046

Fax

(773) 281-0228

NPI assigned

Mar 8, 2016

Last updated

Dec 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Clarence William Brown Jr., M.D., J.D., F.A.A.D.

Title

Director

Phone

(773) 294-0107

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Madeline Margaret Jary, PA-C

  • Physician Assistant
  • Chicago, IL
  • NPI 1215466156
  NPD
• Sangini Dinesh Patel, PAC

  • Dermatology Physician
  • Chicago, IL
  • NPI 1154459246
  NPD

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

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1174984959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853203",
            "telephone_number": "269-985-0021",
            "fax_number": "269-281-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 N. SHERIDAN ROAD",
            "address_2": "STE 912",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-281-0046",
            "fax_number": "773-281-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SKIN AND MOHS SURGERY CENTER S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2020-12-22",
        "certification_date": "2020-11-05",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "773-294-0107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D., J.D., F.A.A.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036096380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• MOHS-Micrographic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.