NPIMap

Organization Active NPI

Associates in Medical and Cosmetic Dermatology, PC

  • Specialist
  • Glen Mills, PA
National Provider Identifier
1477639425
Registry record updated Apr 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ASSOCIATES IN MEDICAL AND COSMETIC DERMATOLOGY, PC
Practice address
500 Evergreen Dr
Suite 20
Glen Mills, PA 19342-1032
Phone
(484) 785-3376
Fax
(610) 358-6913
NPI assigned
Oct 31, 2006
Last updated
Apr 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2012

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

Authorized official

Name
Carol Anne Volz
Title
Practice Administrator
Phone
(484) 785-3376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

500 Evergreen Dr
Suite 20
Glen Mills, PA 19342-1032

Mailing address

500 Evergreen Dr
Suite 20
Glen Mills, PA 19342-1032
Phone (484) 785-3376

Other identifiers 3

IdentifierTypeStateIssuer
469369OtherPAAETNA
0720544000OtherPAIBC
099183OtherPABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040723000240 PA Part B Supplier - Clinic/Group Practice 4385624931 Receives reassigned benefits from 11 practitioners
Practice locations: Glen Mills, PA

National Provider Directory

National Provider Directory

Locations

500 Evergreen Dr
Ste 20
Glen Mills, PA 19342
Phone (484) 785-3376

1011 W Baltimore Pike
Ste 205
West Grove, PA 19390
Phone (610) 869-1251

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333584000000",
    "number": "1477639425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 EVERGREEN DR",
            "address_2": "SUITE 20",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421032",
            "telephone_number": "484-785-3376",
            "fax_number": "610-358-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 EVERGREEN DR",
            "address_2": "SUITE 20",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421032",
            "telephone_number": "484-785-3376",
            "fax_number": "610-358-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATES IN MEDICAL AND COSMETIC DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2012-04-05",
        "status": "A",
        "authorized_official_last_name": "VOLZ",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "484-785-3376"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "469369",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC",
            "identifier": "0720544000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "099183",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Mills, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.