NPIMap

Organization Active NPI

Iowa Dermatology Clinic, PLC

Doing business as Radiant Complexions Dermatology Clinic

  • Dermatology Physician
  • Ankeny, IA
National Provider Identifier
1366916371
Registry record updated Jan 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
IOWA DERMATOLOGY CLINIC, PLC
Doing business as
Radiant Complexions Dermatology Clinic
Practice address
3720 N Ankeny Blvd Ste 101
Ankeny, IA 50023-4605
Phone
(515) 965-6839
NPI assigned
Jan 14, 2019
Last updated
Jan 14, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
IOWA DERMATOLOGY CLINIC, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2019

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

Authorized official

Name
Matthew David Schemmel
Title
Chief Operations Officer
Phone
(515) 226-3116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

3720 N Ankeny Blvd Ste 101
Ankeny, IA 50023-4605

Mailing address

3720 N Ankeny Blvd Ste 101
Ankeny, IA 50023-4605
Phone (515) 965-6839

Other names 1

  • Radiant Complexions Dermatology Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000335 IA Part B Supplier - Clinic/Group Practice 2961394713 Receives reassigned benefits from 25 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshalltown, IA; Cedar Rapids, IA; Mason City, IA; Norwalk, IA; Storm Lake, IA; Urbandale, IA; West Des Moines, IA; Grinnell, IA…

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Part of
Iowa Dermatology Clinic PLC

NPI Registry JSON

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

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1366916371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3720 N ANKENY BLVD STE 101",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500234605",
            "telephone_number": "515-965-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 N ANKENY BLVD STE 101",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500234605",
            "telephone_number": "515-965-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA DERMATOLOGY CLINIC, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IOWA DERMATOLOGY CLINIC, PLC",
        "enumeration_date": "2019-01-14",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "SCHEMMEL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "515-226-3116"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Complexions Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ankeny, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; 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.