NPIMap

Organization Active NPI

Elevated Medspa Corp

Doing business as Elevated DermPath Corp

  • Dermatopathology Physician
  • Indianapolis, IN
National Provider Identifier
1235706946
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
Legal business name
ELEVATED MEDSPA CORP
Doing business as
Elevated DermPath Corp
Elevated Dermatology & MedSpa Corp
Elevated Dermatology& MedSpa Corp2 more in Other names
Practice address
8240 Naab Rd Ste 360
Indianapolis, IN 46260-1987
Phone
(317) 961-6396
NPI assigned
Jun 10, 2021
Last updated
Aug 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Authorized official

Name
Dr. Larry Zhao, MD, FCAP, FPAC, FACP
Title
Ceo, MD
Phone
(317) 961-6396

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Research Clinic/Center 261QR1100X NU
Clinical Medical Laboratory 291U00000X NU
Nutrition Education Nutritionist 133NN1002X NU
Homeopath 175L00000X NU
Dermatology Physician 207N00000X NU
MOHS-Micrographic Surgery Physician 207ND0101X NU
Dermatopathology Physician 207ND0900X NU Primary
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X NU
Procedural Dermatology Physician 207NS0135X NU
Molecular Genetic Pathology (Medical Genetics) Physician 207SM0001X NU
Cytopathology Physician 207ZC0500X NU
Anatomic Pathology Physician 207ZP0101X NU
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU
Public Health & General Preventive Medicine Physician 2083P0901X NU
Health & Wellness Coach 171400000X NU

Addresses

Primary practice location

8240 Naab Rd Ste 360
Indianapolis, IN 46260-1987

Mailing address

8240 Naab Rd Ste 360
Indianapolis, IN 46260-1987
Phone (317) 961-6396

Other names 5

  • Elevated DermPath Corp Doing business as
  • Elevated Dermatology & MedSpa Corp Doing business as
  • Elevated Dermatology& MedSpa Corp Doing business as
  • Indy Dermatology Inc. Doing business as
  • Lei Kay Med Inc Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL 23999 Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23999/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1235706946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8240 NAAB RD STE 360",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601987",
            "telephone_number": "317-961-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8240 NAAB RD STE 360",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601987",
            "telephone_number": "317-961-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATED MEDSPA CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "ZHAO",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO, MD",
        "authorized_official_telephone_number": "317-961-6396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, FCAP, FPAC, FACP"
    },
    "taxonomies": [
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175L00000X",
            "taxonomy_group": "",
            "desc": "Homeopath",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207SM0001X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Molecular Genetic Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "23999",
            "affiliation": "N",
            "endpointDescription": "Athena",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8240 Naab Rd Ste 360",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462601987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Elevated DermPath Corp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elevated Dermatology & MedSpa Corp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elevated Dermatology& MedSpa Corp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Indy Dermatology Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lei Kay Med Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.