Dermatology Associates LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

DERMATOLOGY ASSOCIATES LLC

Practice address

501 Marshall St Ste 606
Jackson, MS 39202-1650

Phone

(601) 355-8555

Fax

(601) 355-2244

NPI assigned

Oct 31, 2007

Organization subpart

No

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

Authorized official

Name

Sabra Sullivan, M. D.NPI 1932176641

Title

Manager/Owner

Phone

(601) 355-8555

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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 1

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.

• Sabra Sullivan, M.D., PHD.

  • Procedural Dermatology Physician
  • Madison, MS
  • NPI 1932176641
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1235318874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST STE 606",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021650",
            "telephone_number": "601-355-8555",
            "fax_number": "601-355-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST STE 606",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021650",
            "telephone_number": "601-355-8555",
            "fax_number": "601-355-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SABRA",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "601-355-8555",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Department of Veterans Affairs
• Department of Veterans Affairs
• Dependable Source Corp. of Ms
• Dept. of Veteran Affairs
• Mattie Derivaux
• Dermatopathology Associates, PLLC
• Benjamin David Derrick, BIBLICAL COUNSELOR
• Jessica Derrick, FNP-C
• Taylor Lynn Derrico, PA-C
• Jagdish Desai, M.D.

• Medical Specialty Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Medical Specialty Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; 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.