NPIMap

Organization Active NPI

M D Aesthetics and Dermatology LLC

  • Dermatology Physician
  • Chicago, IL
National Provider Identifier
1437678133
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036138747 Issued in IL
Legal business name
M D AESTHETICS AND DERMATOLOGY LLC
Practice address
1021 W Adams St
LL # 1
Chicago, IL 60607-2934
Phone
(312) 579-0700
Fax
(312) 579-0701
NPI assigned
Sep 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Gabriel J. Martinez-Diaz, M.D.NPI 1245556695
Title
Medical Director/Dermatologist
Phone
(312) 579-0700

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 036138747 IL Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X 036138747 IL
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X 036138747 IL

Addresses

Primary practice location

1021 W Adams St
LL # 1
Chicago, IL 60607-2934

Mailing address

1021 W. Adams St.
LL #1
Chicago, IL 60607
Phone (312) 579-0700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171222000311 IL Part B Supplier - Clinic/Group Practice 7113285065 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL

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
14D2139347M D Aesthetics and Dermatology1021 W Adams St LL#1, Chicago, IL 60607Certificate of waiverSep 16, 2026

National Provider Directory

National Provider Directory

Locations

1021 W Adams St
Ste LL1
Chicago, IL 60607
Phone (312) 579-0700

1021 W Adams St
Chicago, IL 60607
Phone (312) 579-0700

1021 W Adams St
Lowr
Chicago, IL 60607

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ez_00197

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1437678133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W. ADAMS ST.",
            "address_2": "LL #1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60607",
            "telephone_number": "312-579-0700",
            "fax_number": "312-579-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 W ADAMS ST",
            "address_2": "LL # 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072934",
            "telephone_number": "312-579-0700",
            "fax_number": "312-579-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M D AESTHETICS AND DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-13",
        "last_updated": "2022-07-21",
        "certification_date": "2021-12-06",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ-DIAZ",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/DERMATOLOGIST",
        "authorized_official_telephone_number": "312-579-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036138747",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036138747",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IL",
            "license": "036138747",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.