Bravia Dermatology Group, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BRAVIA DERMATOLOGY GROUP, LLC

Doing business as

Bravia Dermatology

Practice address

7050 Spring MDWS Dr W
Holland, OH 43528-7203

Phone

(419) 948-3376

Fax

(419) 665-3632

NPI assigned

Dec 1, 2016

Last updated

Apr 18, 2024By 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

Matthew A Molenda, MDNPI 1164621579

Title

Owner

Phone

(419) 948-3376

Specialties & licenses 3

Addresses

Other names 1

• Bravia Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

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 4

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.

• Matthew A Molenda, M.D.

  • Dermatology Physician
  • Toledo, OH
  • NPI 1164621579
  Medicare reassignment Care Compare group Authorized official
• Mairead Elizabeth Donovan

  • Physician Assistant
  • Holland, OH
  • NPI 1144099706
  Medicare reassignment Care Compare group
• Emalee Singer, PA-C

  • Physician Assistant
  • Toledo, OH
  • NPI 1710428891
  Medicare reassignment Care Compare group
• Kiley Ann Stevenson-Stalker, PA-C

  • Medical Physician Assistant
  • Holland, OH
  • NPI 1902363716
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1356884837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7050 SPRING MDWS DR W",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435287203",
            "telephone_number": "419-948-3376",
            "fax_number": "419-665-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7050 SPRING MDWS DR W",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435287203",
            "telephone_number": "419-948-3376",
            "fax_number": "419-665-3632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1490 Pinehurst Dr",
            "address_purpose": "LOCATION",
            "city": "Defiance",
            "state": "OH",
            "postal_code": "435128670",
            "country_code": "US",
            "telephone_number": "419-948-3376",
            "fax_number": "419-665-3632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRAVIA DERMATOLOGY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-01",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A",
        "authorized_official_last_name": "MOLENDA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-948-3376",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bravia Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jewel Bocian
• Amy Kristen Boettner, MOTR/L
• Daniella Marie Boling
• Andrea Born
• Stephanie Ann Braden, CNM
• Brighter Paths
• Brilliant Minds Solutions LLP
• Brohl Healthcare, Inc. (Spring Meadows Chiropractic)
• Shawn K Brohl, DC
• Lamonica Bronaugh

• Dermatology Physician in Holland, OH
• Providers in Holland, OH by specialty
• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.