Pine Belt Dermatology and Skin Cancer Center

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

21178 Issued in MS

Legal business name

PINE BELT DERMATOLOGY AND SKIN CANCER CENTER

Practice address

201 S Main St
Petal, MS 39465-2362

Phone

(513) 267-3658

NPI assigned

Oct 20, 2014

Last updated

Oct 20, 2014By 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

Ms. Joy Lynn Moore

Title

Office Manager

Phone

(513) 267-3658

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

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.

• David Bernard Roy, D.O.

  • MOHS-Micrographic Surgery Physician
  • Petal, MS
  • NPI 1801097019
  NPD
• Lauren Ackerman, PA

  • Physician Assistant
  • Hattiesburg, MS
  • NPI 1598501504
  NPD (past)
• David Walton Crasto Jr., DO

  • Dermatology Physician
  • Biloxi, MS
  • NPI 1043771306
  NPD (past)
• Kristen Richardson, P.A.-C

  • Physician Assistant
  • Flowood, MS
  • NPI 1043634702
  NPD (past)
• Eric Carl Torp, M.D.

  • Dermatology Physician
  • Ocean Springs, MS
  • NPI 1841300175
  NPD (past)

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

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413763200000",
    "number": "1497159453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S MAIN ST",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394652362",
            "telephone_number": "513-267-3658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S MAIN ST",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394652362",
            "telephone_number": "513-267-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE BELT DERMATOLOGY AND SKIN CANCER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-20",
        "last_updated": "2014-10-20",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JOY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "513-267-3658",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MS",
            "license": "21178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09537875",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Petal School District
• Petal School District
• Petal School District
• Petal Upper Elementary School
• Petal Urgent Care LLC
• Pine Belt Dermatopathology Lab, PA
• Pioneer Medical Portable Xray,LLC
• Pioneer Medical, LLC
• Hope V Pittman, FNP
• Anna Christine Powell, ATC, LAT, CSCS

• MOHS-Micrographic Surgery Physician in Petal, MS
• Providers in Petal, MS by specialty
• MOHS-Micrographic Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.