Regional Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2006031051 Issued in MO

Legal business name

REGIONAL DERMATOLOGY, LLC

Practice address

1463 Highway 61
Suite B
Festus, MO 63028-4109

Phone

(636) 933-7600

Fax

(636) 933-5900

NPI assigned

May 24, 2010

Last updated

May 24, 2010By 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

Dr. Sarah L Jensen, M.D.NPI 1639119175

Title

Owner

Phone

(636) 933-7600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

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.

• Sarah L Jensen, M.D.

  • Dermatology Physician
  • Festus, MO
  • NPI 1639119175
  Medicare reassignment Care Compare group NPD Authorized official
• Matthew Scheve, PA-C

  • Physician Assistant
  • Festus, MO
  • NPI 1447947312
  Medicare reassignment Care Compare group
• Sarah J Stinson

  • Physician Assistant
  • Festus, MO
  • NPI 1295587129
  Medicare reassignment Care Compare group
• Andrea Bova

  • Family Nurse Practitioner
  • Festus, MO
  • NPI 1740652296
  Medicare reassignment NPD

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

{
    "created_epoch": "1274659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274659200000",
    "number": "1396064879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1463 HIGHWAY 61",
            "address_2": "SUITE B",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284109",
            "telephone_number": "636-933-7600",
            "fax_number": "636-933-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1463 HIGHWAY 61",
            "address_2": "SUITE B",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284109",
            "telephone_number": "636-933-7600",
            "fax_number": "636-933-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-24",
        "last_updated": "2010-05-24",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-933-7600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2006031051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206872806",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Reed
• Ashley N Reese, RNCPNP
• Jeffrey T Reese, M.D.
• Kristen Reese
• Teresa L Reeves, LPC
• Theresa Lynn Rehg, ANP
• Cassidy Reid
• Robin Reifsteck
• Jessica Reiter
• Renal Treatment Centers-Illinois Inc (Crystal City Dialysis Center)

• Dermatology Physician in Festus, MO
• Providers in Festus, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2010; 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.