Madison Dermatology LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

MADISON DERMATOLOGY LLC

Practice address

122 Demaree Dr
Madison, IN 47250-4622

Phone

(812) 265-9191

Fax

(812) 265-1050

NPI assigned

Nov 8, 2006

Last updated

Mar 27, 2013By 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. Eduardo Gabriel Rivera, M.D.NPI 1457428096

Title

Owner

Phone

(812) 265-9191

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• skin solutions llc Other name

Medicare fee-for-service enrollment

Enrolled in IN

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 5

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.

• Eduardo G Rivera, M.D.

  • MOHS-Micrographic Surgery Physician
  • Madison, IN
  • NPI 1457428096
  Medicare reassignment Care Compare group NPD Authorized official
• Patricia A Hoffmann, NP

  • Family Nurse Practitioner
  • Columbus, IN
  • NPI 1528197803
  Medicare reassignment Care Compare group NPD
• Karma A Kristufek, PA-C

  • Medical Physician Assistant
  • Madison, IN
  • NPI 1245430362
  Medicare reassignment Care Compare group
• Patricia J. Lisinski, PA

  • Physician Assistant
  • Columbus, IN
  • NPI 1033419437
  Medicare reassignment Care Compare group
• Patricia C Mader, A.R.N.P.

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1285639005
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364342400000",
    "number": "1215007455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 DEMAREE DR",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472504622",
            "telephone_number": "812-265-9191",
            "fax_number": "812-265-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 DEMAREE DR",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472504622",
            "telephone_number": "812-265-9191",
            "fax_number": "812-265-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2013-03-27",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "EDUARDO",
        "authorized_official_middle_name": "GABRIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-265-9191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA FOR COLUMBUS LOCATIO",
            "identifier": "15D1048313",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA FOR MADISON LOCATION",
            "identifier": "15D0952312",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "skin solutions llc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bryan E Maddox, NP
• Joanne Maddux, OTR
• Madison Apothecary Inc.
• Madison Clinic
• Madison Consolidated School
• Madison Direct Health
• Madison Eye Center LLC
• Madison Family Dentistry
• Madison Healthcare and Wellness Ctr. PC
• Madison Hearing Health, LLC

• Procedural Dermatology Physician in Madison, IN
• Providers in Madison, IN by specialty
• Procedural Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; 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.