Southside Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SOUTHSIDE DERMATOLOGY PLLC

Practice address

333 S 38TH St Ste E
Muskogee, OK 74401-4937

Phone

(918) 760-0700

NPI assigned

Mar 28, 2022

Organization subpart

No

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

Authorized official

Name

Alison Fischer

Title

Owner

Phone

(918) 760-0700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Southside Dermatology PLLC

  • Dermatology Physician
  • Broken Arrow, OK
  • NPI 1073263380

  O20180802002933

  Same enrollment
• Southside Dermatology PLLC

  • Dermatology Physician
  • Tulsa, OK
  • NPI 1750877072

  O20180802002933

  Same enrollment

Practitioners 5

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

• Autum Michole Caldwell, P.A. - C

  • Physician Assistant
  • Tulsa, OK
  • NPI 1396093647
  NPD
• Julie Kaye Curtis, P A C

  • Physician Assistant
  • Tulsa, OK
  • NPI 1912998857
  NPD
• Michelle Renee Lapidus, P.A.-C

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1962508457
  NPD
• Joe Randall Monroe, PA

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1083613822
  NPD
• Amy Michelle Sheffer

  • Medical Physician Assistant
  • Tulsa, OK
  • NPI 1689382368
  NPD

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1205586500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6966 S UTICA AVE STE 225",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363903",
            "telephone_number": "918-492-6333",
            "fax_number": "918-493-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S 38TH ST STE E",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744014937",
            "telephone_number": "918-760-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "FISCHER",
        "authorized_official_first_name": "ALISON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-760-0700"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Lee Soap
• Solara Hospital Muskogee,LLC (Cornerstone Specialty Hospitals Broken Arrow)
• Song Byrd Behavioral Health, Inc
• Michael L Soper, M.D.
• Julie Hardin Southern
• Michael Gene Spain, M.D.
• Tony William Spatz, M.D.
• Kendall Wayne Spears, BGS,BHRS
• Susan Spears
• Misty D. Specht-Pilgrim, R.D., L.D.

• Dermatology Physician in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.