NPIMap

Organization Active NPI

New Dermatology Group LTD

  • Dermatology Physician
  • Green Bay, WI
National Provider Identifier
1356784334
Registry record updated Apr 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
53110-20 Issued in WI
Legal business name
NEW DERMATOLOGY GROUP LTD
Practice address
1747 Shawano Ave
Green Bay, WI 54303-3243
Phone
(920) 965-0345
NPI assigned
Apr 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2013

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

Authorized official

Name
Kevan LewisNPI 1497970560
Title
Owner
Phone
(920) 965-0345

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 53110-20 WI Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X 53110-20 WI
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X 53110-20 WI
Clinical & Laboratory Dermatological Immunology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NI0002X 53110-20 WI
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X 53110-20 WI

Addresses

Primary practice location

1747 Shawano Ave
Green Bay, WI 54303-3243

Mailing address

2221 S Webster Ave
Ste 241
Green Bay, WI 54301-2158

National Provider Directory

National Provider Directory
Tax ID family
New Dermatology Group LTD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1365465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1356784334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 S WEBSTER AVE",
            "address_2": "STE 241",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033243",
            "telephone_number": "920-965-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW DERMATOLOGY GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-09",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "KEVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-965-0345"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "WI",
            "license": "53110-20",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "WI",
            "license": "53110-20",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "WI",
            "license": "53110-20",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "WI",
            "license": "53110-20",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "WI",
            "license": "53110-20",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.