Regional Dermatology PLLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

34192 Issued in KY

Legal business name

REGIONAL DERMATOLOGY PLLC

Doing business as

Skin MD
SkinMD

Practice address

989 Governors LN Ste 220
Lexington, KY 40513-1175

Phone

(859) 296-7546

Fax

(859) 721-0829

NPI assigned

Jun 21, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samuel J Pruden II, MDNPI 1871593996

Title

President

Phone

(859) 296-7546

Specialties & licenses 5

Addresses

Other names 2

• Skin MD Doing business as
• SkinMD Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

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.

• Samuel J Pruden II, MD

  • MOHS-Micrographic Surgery Physician
  • Lexington, KY
  • NPI 1871593996
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1255851200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "989 GOVERNORS LN STE 220",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131175",
            "telephone_number": "859-296-7546",
            "fax_number": "859-721-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 GOVERNORS LN STE 220",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131175",
            "telephone_number": "859-296-7546",
            "fax_number": "859-721-0829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PRUDEN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-296-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "KY",
            "license": "34192",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "KY",
            "license": "34192",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "KY",
            "license": "34192",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "KY",
            "license": "34192",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skin MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Skin MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SkinMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sherri Reffett, OTR/L
• Refuge for Women Ky Emergency Housing
• Refuge for Women, Inc
• Regency Chiropractic
• Reginas Quality Care
• Rehab Medical, LLC
• Rehab Systems, LLC
• Rehabcare Group East, LLC
• Andrew Joseph Reichard, MD
• Amanda Jane Reid, NP

• MOHS-Micrographic Surgery Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• MOHS-Micrographic Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.