NPIMap

Organization Active NPI

Dermasap PLLC

  • Dermatology Physician
  • Quincy, MA
National Provider Identifier
1477937480
Registry record updated Dec 27, 2016
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Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
49076 Issued in MA
Legal business name
DERMASAP PLLC
Practice address
500 Congress St
B1
Quincy, MA 02169-0908
Phone
(617) 472-6764
NPI assigned
Jul 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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

Authorized official

Name
Staci Goodwin
Title
Om
Phone
(617) 472-6764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 49076 MA Primary

Addresses

Primary practice location

500 Congress St
B1
Quincy, MA 02169-0908

Mailing address

500 Congress St
B1
Quincy, MA 02169-0908
Phone (617) 472-6764

Other identifiers 1

IdentifierTypeStateIssuer
043214763MedicaidMA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482796800000",
    "number": "1477937480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 CONGRESS ST",
            "address_2": "B1",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021690908",
            "telephone_number": "617-472-6764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CONGRESS ST",
            "address_2": "B1",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021690908",
            "telephone_number": "617-472-6764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMASAP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-20",
        "last_updated": "2016-12-27",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "STACI",
        "authorized_official_title_or_position": "OM",
        "authorized_official_telephone_number": "617-472-6764"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "49076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043214763",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.