Booth Dermatology Group, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BOOTH DERMATOLOGY GROUP, PC

Practice address

12050 N Michigan Rd
Zionsville, IN 46077-8782

Phone

(317) 848-2427

Fax

(317) 848-2434

NPI assigned

Jan 23, 2006

Last updated

Jun 15, 2020By 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. Sally A Booth, MDNPI 1669452884

Title

President

Phone

(317) 848-2427

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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 5

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.

• Sally A Booth, MD

  • Dermatology Physician
  • Zionsville, IN
  • NPI 1669452884
  Medicare reassignment Care Compare group NPD Authorized official
• Christy Lee Waterman, MD

  • Dermatology Physician
  • Zionsville, IN
  • NPI 1194287078
  Medicare reassignment Care Compare group NPD
• Matthew Bradley Strausburg, M.D.

  • Dermatology Physician
  • Indianapolis, IN
  • NPI 1093057911
  Medicare reassignment NPD
• Lynn Burford, O.D.

  • Optometrist
  • Indianapolis, IN
  • NPI 1992875868
  NPD (past)
• Olivia Rochelle Jahnke, OD

  • Optometrist
  • Indianapolis, IN
  • NPI 1831627116
  NPD (past)

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1346220563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12050 N MICHIGAN RD",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460778782",
            "telephone_number": "317-848-2427",
            "fax_number": "317-848-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12050 N MICHIGAN RD",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460778782",
            "telephone_number": "317-848-2427",
            "fax_number": "317-848-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOTH DERMATOLOGY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-23",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "SALLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-848-2427",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Ann Bonar
• Kurtis Brian Bonner, PT
• Rachael Bonnet
• Natalie Boo, PHARM D
• Nancy Boone, FNP-C
• Sally A Booth, MD
• Sandra Uhland Borth, LMHC
• Amanda Greenlee Bourff, DDS
• Amber Bow
• Mary Bowman, P.T.

• Dermatology Physician in Zionsville, IN
• Providers in Zionsville, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; 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.