Dermatopathology Associates, PLLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

25D0688888 Issued in MO

Legal business name

DERMATOPATHOLOGY ASSOCIATES, PLLC

Practice address

3120 Old Canton Rd
Jackson, MS 39216

Phone

(601) 362-9851

Fax

(601) 982-9025

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Buu T Duong, MDNPI 1740572676

Title

Member

Phone

(601) 362-9851

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MS

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Buu Duong, MD

  • Dermatopathology (Pathology) Physician
  • Jackson, MS
  • NPI 1740572676
  NPD Authorized official
• Jennifer S Schulmeier, MD

  • Dermatopathology (Pathology) Physician
  • Jackson, MS
  • NPI 1033432653
  NPD
• Kellen Dawson

  • Dermatopathology (Pathology) Physician
  • Jackson, MS
  • NPI 1033615919

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1356374912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3528",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392073528",
            "telephone_number": "601-362-9851",
            "fax_number": "601-982-9025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-362-9851",
            "fax_number": "601-982-9025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOPATHOLOGY ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "DUONG",
        "authorized_official_first_name": "BUU",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "601-362-9851",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MO",
            "license": "25D0688888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1964310",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120024",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "690008330",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135488709",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009931780",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Department of Veterans Affairs
• Dependable Source Corp. of Ms
• Dept. of Veteran Affairs
• Mattie Derivaux
• Dermatology Associates LLC
• Benjamin David Derrick, BIBLICAL COUNSELOR
• Jessica Derrick, FNP-C
• Taylor Lynn Derrico, PA-C
• Jagdish Desai, M.D.
• Shivum Kumar Desai

• Clinical Medical Laboratory in Jackson, MS
• Providers in Jackson, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; 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.