NPIMap

Organization Active NPI

Deerfield Dermatology Associates, LTD.

  • Dermatology Physician
  • Deerfield, IL
National Provider Identifier
1225127244
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
042-618435 Issued in IL
Legal business name
DEERFIELD DERMATOLOGY ASSOCIATES, LTD.
Practice address
707 Lake Cook Rd
Suite #280
Deerfield, IL 60015-4909
Phone
(847) 480-0004
Fax
(847) 480-8707
NPI assigned
Oct 11, 2006
Last updated
Nov 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Authorized official

Name
Melissa Gottfredsen
Title
Administrator
Phone
(847) 480-0004

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 042-618435 IL Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

707 Lake Cook Rd
Suite #280
Deerfield, IL 60015-4909

Mailing address

707 Lake Cook Rd
Suite #280
Deerfield, IL 60015-4909
Phone (847) 480-0004

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060221000021 IL Part B Supplier - Clinic/Group Practice 6204841760 Receives reassigned benefits from 19 practitioners
Practice locations: Deerfield, IL; Gurnee, IL

National Provider Directory

National Provider Directory

Locations

36100 N Brookside Dr
Gurnee, IL 60031
Phone (847) 535-7900

36100 N Brookside Dr
Ste 100
Gurnee, IL 60031
Phone (847) 244-2500

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1225127244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 LAKE COOK RD",
            "address_2": "SUITE #280",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154909",
            "telephone_number": "847-480-0004",
            "fax_number": "847-480-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 LAKE COOK RD",
            "address_2": "SUITE #280",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154909",
            "telephone_number": "847-480-0004",
            "fax_number": "847-480-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEERFIELD DERMATOLOGY ASSOCIATES, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "GOTTFREDSEN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "847-480-0004"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "042-618435",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.