Advanced Dermatology Center, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0329 Issued in SD

Legal business name

ADVANCED DERMATOLOGY CENTER, PC

Practice address

710 Saint Anne Street
Rapid City, SD 57701

Phone

(605) 343-8000

Fax

(605) 343-8262

NPI assigned

Feb 6, 2007

Last updated

Feb 13, 2018By 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

Mrs. Sheila Oday Boddicker

Title

Office Manager

Phone

(605) 343-8000

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

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.

• Marc E Boddicker, MD

  • Dermatology Physician
  • Rapid City, SD
  • NPI 1235103060
  Medicare reassignment NPD
• Jonathan Dean Medeck, PA-C

  • Physician Assistant
  • Rapid City, SD
  • NPI 1467426387
  Medicare reassignment
• Randall Maharry

  • Dermatology Physician
  • Estes Park, CO
  • NPI 1730592320
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518480000000",
    "number": "1346389178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3468",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577093468",
            "telephone_number": "605-343-8000",
            "fax_number": "605-343-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 SAINT ANNE STREET",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "57701",
            "telephone_number": "605-343-8000",
            "fax_number": "605-343-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2018-02-13",
        "status": "A",
        "authorized_official_last_name": "BODDICKER",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "ODAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "605-343-8000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SD",
            "license": "0329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0006246",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Dermatology Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; 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.