NPIMap

Organization Active NPI

Dermatology Specialists of Omaha LLC

  • Dermatology Physician
  • Omaha, NE
National Provider Identifier
1457551889
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY SPECIALISTS OF OMAHA LLC
Practice address
909 N 96TH St Ste 201
Omaha, NE 68114-2508
Phone
(402) 330-4555
Fax
(402) 330-4626
NPI assigned
Jul 24, 2007
Last updated
May 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Authorized official

Name
Damita K Gilford
Title
Director of Business Office Service
Phone
(402) 763-1518

Specialties & licenses 1

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

Addresses

Primary practice location

909 N 96TH St Ste 201
Omaha, NE 68114-2508

Mailing address

909 N 96TH St Ste 201
Omaha, NE 68114-2508
Phone (402) 330-4555

Other names 1

  • Dermatology Surgery Center Group, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070814000692 NE Part B Supplier - Clinic/Group Practice 7113018581 Receives reassigned benefits from 13 practitioners
Practice locations: Omaha, NE; Elkhorn, NE
O20140808000136 IA Part B Supplier - Clinic/Group Practice 7113018581 Receives reassigned benefits from 1 practitioner
Practice locations: Council Bluffs, IA

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
28D2317849Dermatology Specialists of Omaha Research909 N 96TH St, Suite 104, Omaha, NE 68114Certificate of waiverJan 30, 2027

National Provider Directory

National Provider Directory

Locations

808 E Pierce St
Fl 2
Council Bluffs, IA 51503

11623 Arbor St
Ste 102
Omaha, NE 68144
Phone (402) 330-4555

909 N 96th St
Ste 104
Omaha, NE 68114

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": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1457551889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 N 96TH ST STE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142508",
            "telephone_number": "402-330-4555",
            "fax_number": "402-330-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 N 96TH ST STE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142508",
            "telephone_number": "402-330-4555",
            "fax_number": "402-330-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SPECIALISTS OF OMAHA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A",
        "authorized_official_last_name": "GILFORD",
        "authorized_official_first_name": "DAMITA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OFFICE SERVICE",
        "authorized_official_telephone_number": "402-763-1518"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Surgery Center Group, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Dermatology Surgery Center Group, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.