Skin Group PLLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

25359 Issued in KY

Legal business name

SKIN GROUP PLLC

Practice address

2307 River Rd Ste 101
Louisville, KY 40206-5000

Phone

(502) 583-6647

Fax

(502) 585-4824

NPI assigned

Apr 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Robert H Zax, M.D.NPI 1689659781

Title

President

Phone

(502) 583-6647

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 9

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

• Robert Henry Zax, MD

  • MOHS-Micrographic Surgery Physician
  • Louisville, KY
  • NPI 1689659781
  Medicare reassignment Care Compare group NPD Authorized official
• Tyler Roshak

  • Physician Assistant
  • Louisville, KY
  • NPI 1952091480
  Medicare reassignment Care Compare group
• William B Warrick, PA.C

  • Physician Assistant
  • Louisville, KY
  • NPI 1578522199
  Medicare reassignment Care Compare group
• Brianna Langenkamp, PA

  • Physician Assistant
  • New Albany, IN
  • NPI 1053877878

  KY

  Medicare reassignment Care Compare group
• Shannon England, APRN

  • Dermatology Physician
  • Louisville, KY
  • NPI 1851665038
  Medicare reassignment NPD
• Michelle H Hannigan, APRN

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1518983188
  Medicare reassignment NPD
• Brittany Nicole Boylan, APRN

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1073877635
  Medicare reassignment
• Katie Leigh Tarter, PA-C

  • Physician Assistant
  • Lexington, KY
  • NPI 1528712577
  Medicare reassignment
• Victoria A Yatsuknenko, PA-C

  • Physician Assistant
  • Louisville, KY
  • NPI 1013168715
  Medicare reassignment

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1366564494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36422",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402336422",
            "telephone_number": "502-583-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 RIVER RD STE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402065000",
            "telephone_number": "502-583-6647",
            "fax_number": "502-585-4824"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1868 W Hebron Ln Ste 200",
            "address_purpose": "LOCATION",
            "city": "Shepherdsville",
            "state": "KY",
            "postal_code": "401657481",
            "country_code": "US",
            "telephone_number": "502-583-6647",
            "fax_number": "502-585-4824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SKIN GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "ZAX",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-583-6647",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "KY",
            "license": "25359",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1034",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "4440P",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78904968",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "18D0934789",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65938797",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "DA0326",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Skiles, D.M.D.
• Skillz 4 Life Therapy
• Skillz 4 Life, Inc
• Skillz 4 Life, Inc.
• Skin Group PLLC
• Aaron Neal Skinner, MD
• Amy Ruth Skinner, MS OTR/L
• John P. Skinner, D.M.D.
• Mary T Skinner, ARNP-C
• Sarah Ashley Skinner, APRN

• MOHS-Micrographic Surgery Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• MOHS-Micrographic Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.