NPIMap

Organization Active NPI

Ohio Premier Dermatology, LLC

  • Dermatology Physician
  • Sunbury, OH
National Provider Identifier
1316233158
Registry record updated Jun 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
34.009063 Issued in OH
Legal business name
OHIO PREMIER DERMATOLOGY, LLC
Practice address
44 Kintner Pkwy
Suite B
Sunbury, OH 43074-9368
Phone
(740) 965-0855
Fax
(740) 965-0836
NPI assigned
Jun 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2011

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

Authorized official

Name
Dr. Ramona Maria Sarsama Nixon, D.O.NPI 1558524033
Title
Dermatologist & Owner
Phone
(614) 256-5422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 34.009063 OH Primary

Addresses

Primary practice location

44 Kintner Pkwy
Suite B
Sunbury, OH 43074-9368

Mailing address

44 Kintner Pkwy
Suite B
Sunbury, OH 43074-9368
Phone (740) 965-0855

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140703001033 OH Part B Supplier - Clinic/Group Practice 3577788678 Receives reassigned benefits from 2 practitioners
Practice locations: Sunbury, OH

National Provider Directory

National Provider Directory

Locations

44 Kintner Pkwy
Ste B
Sunbury, OH 43074
Phone (740) 965-0855

Practitioners & affiliated clinicians

Practitioners 2

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": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308528000000",
    "number": "1316233158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 KINTNER PKWY",
            "address_2": "SUITE B",
            "city": "SUNBURY",
            "state": "OH",
            "postal_code": "430749368",
            "telephone_number": "740-965-0855",
            "fax_number": "740-965-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 KINTNER PKWY",
            "address_2": "SUITE B",
            "city": "SUNBURY",
            "state": "OH",
            "postal_code": "430749368",
            "telephone_number": "740-965-0855",
            "fax_number": "740-965-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO PREMIER DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-06-20",
        "status": "A",
        "authorized_official_last_name": "SARSAMA NIXON",
        "authorized_official_first_name": "RAMONA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "DERMATOLOGIST & OWNER",
        "authorized_official_telephone_number": "614-256-5422",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "OH",
            "license": "34.009063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunbury, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; 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.