NPIMap

Organization Active NPI

Equity Dermatology, PLLC

  • Dermatology Physician
  • Bowling Green, KY
National Provider Identifier
1225855307
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EQUITY DERMATOLOGY, PLLC
Practice address
1802 Rockingham Ave
Bowling Green, KY 42104-3348
Phone
(270) 213-7777
Fax
(844) 444-1250
NPI assigned
Sep 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

Name
James T Allred, MDNPI 1780946160
Title
Doctor/Owner
Phone
(615) 428-4063

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Research Clinic/Center 261QR1100X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

1802 Rockingham Ave
Bowling Green, KY 42104-3348

Mailing address

1802 Rockingham Ave
Bowling Green, KY 42104-3348
Phone (270) 213-7777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250110002086 KY Part B Supplier - Clinic/Group Practice 3577091016 Receives reassigned benefits from 2 practitioners
Practice locations: Bowling Green, KY

National Provider Directory

National Provider Directory

Locations

610 Cave Mill Rd
Bowling Green, KY 42104
Phone (270) 467-7400

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1225855307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 ROCKINGHAM AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043348",
            "telephone_number": "270-213-7777",
            "fax_number": "844-444-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 ROCKINGHAM AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043348",
            "telephone_number": "270-213-7777",
            "fax_number": "844-444-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUITY DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "ALLRED",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "615-428-4063",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; 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.