St. Louis Dermatology Center LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2017039492 Issued in MO

Legal business name

ST. LOUIS DERMATOLOGY CENTER LLC

Practice address

8888 Ladue Rd Ste 210
Saint Louis, MO 63124-2056

Phone

(314) 474-0114

Fax

(314) 526-2686

NPI assigned

Jan 18, 2018

Last updated

Jan 18, 2018By 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

Osamuede Osemwota, MDNPI 1275972432

Title

Owner

Phone

(314) 474-0114

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

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.

• Osamuede Osemwota, MD

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1275972432
  Medicare reassignment Authorized official
• Rachel Heet, FNP- BC

  • Family Nurse Practitioner
  • Saint Louis, MO
  • NPI 1295215101
  Medicare reassignment
• Abby Rachel Rosenberg Johnson, MD

  • Dermatology Physician
  • Clayton, MO
  • NPI 1033672662
  Medicare reassignment
• Kent A Guisinger, DO

  • Family Medicine Physician
  • Lancaster, OH
  • NPI 1619955325
  NPD

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516233600000",
    "number": "1437667920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 ROSEDALE AVE APT 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631121427",
            "telephone_number": "334-221-2357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8888 LADUE RD STE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631242056",
            "telephone_number": "314-474-0114",
            "fax_number": "314-526-2686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS DERMATOLOGY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-01-18",
        "status": "A",
        "authorized_official_last_name": "OSEMWOTA",
        "authorized_official_first_name": "OSAMUEDE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-474-0114",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2017039492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Louis County Dept of Public Health
• St. Louis County Nephrology
• St. Louis DBT, LLC
• St. Louis Department of Veterans Affairs
• St. Louis Dermatology and Surgery Center, PC
• St. Louis Doula Project Inc
• St. Louis Effort for AIDS
• St. Louis Eye Care Specialists, LLC
• St. Louis Eye Clinic
• St. Louis Eye Clinic

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; 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.