NPIMap

Organization Active NPI

Dermsouth, PA

  • Dermatology Physician
  • Pearland, TX
National Provider Identifier
1386842417
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMSOUTH, PA
Practice address
10970 Shadow Creek Pkwy
Suite 340
Pearland, TX 77584-0100
Phone
(713) 791-9966
NPI assigned
Jul 10, 2007
Last updated
Dec 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Authorized official

Name
Dr. Leonard Harry Goldberg, M.D.NPI 1023001708
Title
M.D.
Phone
(713) 791-9966

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

10970 Shadow Creek Pkwy
Suite 340
Pearland, TX 77584-0100

Mailing address

6700 West Loop South
Suite #500
Bellaire, TX 77401
Phone (713) 791-9966

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071107000727 TX Part B Supplier - Clinic/Group Practice 2961599931 Receives reassigned benefits from 6 practitioners
Practice locations: Pearland, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2097373Dermsouth PA10970 Shadow Creek Parkway Suite 340, Pearland, TX 77584ComplianceAug 20, 2027

National Provider Directory

National Provider Directory

Locations

819 Peakwood Dr
Houston, TX 77090
Phone (281) 444-1288

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1386842417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 WEST LOOP SOUTH",
            "address_2": "SUITE #500",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "77401",
            "telephone_number": "713-791-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10970 SHADOW CREEK PKWY",
            "address_2": "SUITE 340",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775840100",
            "telephone_number": "713-791-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMSOUTH, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "HARRY",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "713-791-9966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.