Em Dimitri DO PMC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

14885R Issued in LA

Legal business name

EM DIMITRI DO PMC

Doing business as

Dimitri Dermatology

Practice address

624 Highway 90
Bay St Louis, MS 39520-2715

Phone

(228) 467-5644

Fax

(228) 467-9961

NPI assigned

May 10, 2012

Last updated

May 10, 2012By 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

Karen Rachel Drake

Title

Credentialing Coordinator

Phone

(985) 643-4512

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dimitri Dermatology Doing business as

Tax ID family

Dimitri Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dimitri Dermatology

  • Dermatology Physician
  • Slidell, LA
  • NPI 1134373483
  NPD tax ID

Locations

Practitioners 3

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.

• Matthew Peter Brennan, MD

  • General Practice Physician
  • Bay St Louis, MS
  • NPI 1174799688
  NPD (past)
• Marie Saxon Ford, FNP

  • Family Nurse Practitioner
  • Meridian, MS
  • NPI 1265869895
  NPD (past)
• Lauren Ramsey

  • Physician Assistant
  • Memphis, TN
  • NPI 1922653526
  NPD (past)

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

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1285993337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 GATEWAY DR",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615540",
            "telephone_number": "985-643-4512",
            "fax_number": "985-643-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 HIGHWAY 90",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395202715",
            "telephone_number": "228-467-5644",
            "fax_number": "228-467-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EM DIMITRI DO PMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "RACHEL",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "985-643-4512"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MS",
            "license": "21866",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "LA",
            "license": "14885R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07454201",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dimitri Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Lynn Douglas, MD
• Ally Elizabeth Duet, PA-C
• Dunbar Village L.P.
• Dynamic Diagnostics LLC
• Penny W Elkins
• Ethel W Hetrick PHD PLLC
• Keith M Everman, D.C.
• Meghan Flynt, LPC
• Maghan Foos, FNP-C
• Carol Sullivan Fraiser, LMSW

• Dermatology Physician in Bay St Louis, MS
• Providers in Bay St Louis, MS by specialty
• Dermatology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.