Elderderm SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

36-087861 Issued in IL

Legal business name

ELDERDERM SC

Practice address

400 E Randolph St
Suite 2407
Chicago, IL 60601-7329

Phone

(312) 371-7517

NPI assigned

Jan 4, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Scott Brent Phillips, M.D.NPI 1053369967

Title

President / Ceo

Phone

(312) 371-7517

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6372/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Scott Brent Phillips, MD

  • Dermatology Physician
  • Chicago, IL
  • NPI 1053369967
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374105600000",
    "number": "1245577667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E RANDOLPH ST",
            "address_2": "SUITE 2407",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017329",
            "telephone_number": "312-371-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E RANDOLPH ST",
            "address_2": "SUITE 2407",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017329",
            "telephone_number": "312-371-7517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERDERM SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-04",
        "last_updated": "2013-07-18",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "312-371-7517",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "36-087861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antoinette Von Eldemire, LPC
• Anne Elizabeth Elder, MS, OTR/L
• Ariana Elder, MD
• Rachel Elder, PT,DPT
• Sarah Elder, LCSW
• Mohamed Ahmed Elderei, M.B.,B.CH., MSC.
• Elderly Errands Homemakers Inc
• Elderly Errands Inc
• Eldin Karaikovic M.D. PHD, S.C.
• Lauren Eldredge, MD

• Dermatology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; 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.