Dermatologic Surgery Center of Northeast Ohio Inc

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

35076146P Issued in OH

Legal business name

DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC

Practice address

1133 Medina Rd
Suite 100
Medina, OH 44256-0000

Phone

(330) 238-4350

Fax

(330) 239-4584

NPI assigned

Dec 13, 2011

Last updated

Feb 27, 2012By 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

Jennifer Popovsky, MDNPI 1952307324

Title

President

Phone

(330) 239-4350

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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 7

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.

• Jennifer L Popovsky, M.D.

  • MOHS-Micrographic Surgery Physician
  • Medina, OH
  • NPI 1952307324
  Medicare reassignment Care Compare group NPD Authorized official
• Carl Barrick, DO

  • Dermatology Physician
  • Medina, OH
  • NPI 1679965289
  Medicare reassignment Care Compare group NPD
• Hannah Elizabeth Kupetz, PA-C

  • Physician Assistant
  • Medina, OH
  • NPI 1336966068
  Medicare reassignment Care Compare group
• Elise Craig, D.O.

  • Dermatology Physician
  • Medina, OH
  • NPI 1922533876
  Medicare reassignment NPD
• Darla J Hadden, PA-C

  • Physician Assistant
  • Westlake, OH
  • NPI 1417976960
  Medicare reassignment
• Heidi Renee Gum, PA

  • Physician Assistant
  • Hendersonville, NC
  • NPI 1346232071
  Care Compare group
• Amy Davis, FNP-C

  • Family Nurse Practitioner
  • Medina, OH
  • NPI 1407321193
  NPD (past)

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1205104601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 MEDINA RD",
            "address_2": "SUITE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "44256",
            "telephone_number": "330-239-4350",
            "fax_number": "330-239-4584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 MEDINA RD",
            "address_2": "SUITE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442560000",
            "telephone_number": "330-238-4350",
            "fax_number": "330-239-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "POPOVSKY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-239-4350",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "OH",
            "license": "35076146P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2190785",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alice M Denton, M.D.
• Stephen Douglas Depp
• Tammy Depriest
• Kathleen Ellen Derga, MACCC/SLP
• Kriszti R Derga
• Lisa Webb Derrick, M.D.
• Deborah Daline Detmayer
• Kate Deville, PT, DPT
• Deborah Jane Devlin, LSW, LPCC
• Kari Devore

• MOHS-Micrographic Surgery Physician in Medina, OH
• Providers in Medina, OH by specialty
• MOHS-Micrographic Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; 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.