NPIMap

Organization Active NPI

Advanced Dermatology Skin Cancer & Laser Surgery Center P.C.

  • Dermatology Physician
  • Evergreen, CO
National Provider Identifier
1306448220
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ADVANCED DERMATOLOGY SKIN CANCER & LASER SURGERY CENTER P.C.
Practice address
30960 Stagecoach Blvd
Ste W140
Evergreen, CO 80439-7897
Phone
(303) 670-7065
Fax
(303) 670-7067
NPI assigned
Nov 16, 2020
Last updated
Nov 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Gregory G Papadeas, D.O.NPI 1730181405
Title
Doctor of Osteopathic Medicine
Phone
(303) 368-8611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

30960 Stagecoach Blvd
Ste W140
Evergreen, CO 80439-7897

Mailing address

3464 S. Willow Street
Suite 194
Denver, CO 80231-4531
Phone (303) 755-2900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040313000244 CO Part B Supplier - Clinic/Group Practice 6709775133 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centennial, CO; Frisco, CO; Evergreen, CO; Castle Rock, CO; Aurora, CO

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dermatology SK4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

30960 Stagecoach Blvd
Ste W140
Evergreen, CO 80439
Phone (303) 670-7065

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1306448220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3464 S. WILLOW STREET",
            "address_2": "SUITE 194",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802314531",
            "telephone_number": "303-755-2900",
            "fax_number": "303-755-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30960 STAGECOACH BLVD",
            "address_2": "STE W140",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804397897",
            "telephone_number": "303-670-7065",
            "fax_number": "303-670-7067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY SKIN CANCER & LASER SURGERY CENTER P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "PAPADEAS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DOCTOR OF OSTEOPATHIC MEDICINE",
        "authorized_official_telephone_number": "303-368-8611",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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.