NPIMap

Organization Active NPI

Beavercreek Dermatology LLC

  • Nurse Practitioner
  • Beavercreek, OH
National Provider Identifier
1265535140
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
BEAVERCREEK DERMATOLOGY LLC
Practice address
3572 Dayton-Xenia Rd
Suite 105
Beavercreek, OH 45432-2838
Phone
(937) 427-4600
Fax
(937) 427-4520
NPI assigned
Sep 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Kathryn V Balazs, DO
Title
Practice Owner Physician
Phone
(937) 427-4600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

3572 Dayton-Xenia Rd
Suite 105
Beavercreek, OH 45432-2838

Mailing address

3572 Dayton-Xenia Rd
Suite 105
Beavercreek, OH 45432-2838
Phone (937) 427-4600

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1265535140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3572 DAYTON-XENIA RD",
            "address_2": "SUITE 105",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454322838",
            "telephone_number": "937-427-4600",
            "fax_number": "937-427-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3572 DAYTON-XENIA RD",
            "address_2": "SUITE 105",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454322838",
            "telephone_number": "937-427-4600",
            "fax_number": "937-427-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVERCREEK DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BALAZS",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRACTICE OWNER PHYSICIAN",
        "authorized_official_telephone_number": "937-427-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beavercreek, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.