NPIMap

Organization Active NPI

Dermatology Associates LTD

  • Specialist
  • Tinley Park, IL
National Provider Identifier
1497968945
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
042618383 Issued in IL
Legal business name
DERMATOLOGY ASSOCIATES LTD
Practice address
18425 W Creek Dr
Ste F
Tinley Park, IL 60477-6767
Phone
(708) 444-8300
Fax
(708) 444-8301
NPI assigned
May 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Authorized official

Name
Vivek IyengarNPI 1073589297
Title
Owner
Phone
(708) 444-8300

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 042618383 IL Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

18425 W Creek Dr
Ste F
Tinley Park, IL 60477-6767

Mailing address

18425 W Creek Dr
Ste F
Tinley Park, IL 60477-6767
Phone (708) 444-8300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address viyengar284099@direct.myadvocateaurora.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050120000764 IL Part B Supplier - Clinic/Group Practice 8628027273 Receives reassigned benefits from 12 practitioners
Practice locations: New Lenox, IL; Palos Heights, IL; Tinley Park, 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
14D0418678Dermatology Associates18425 W Creek Dr, Ste F, Tinley Park, IL 60477ComplianceFeb 9, 2028

National Provider Directory

National Provider Directory

Locations

420 Nelson Rd
#422
New Lenox, IL 60451

13401 S Ridgeland Ave
Palos Heights, IL 60463
Phone (708) 444-8300

18425 West Creek Dr
Ste F
Tinley Park, IL 60477
Phone (708) 444-8300

Interoperability endpoints

  • Direct secure messaging: viyengar284099@direct.myadvocateaurora.org

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1497968945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18425 W CREEK DR",
            "address_2": "STE F",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776767",
            "telephone_number": "708-444-8300",
            "fax_number": "708-444-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18425 W CREEK DR",
            "address_2": "STE F",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776767",
            "telephone_number": "708-444-8300",
            "fax_number": "708-444-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2021-12-07",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "IYENGAR",
        "authorized_official_first_name": "VIVEK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-444-8300"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "042618383",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "viyengar284099@direct.myadvocateaurora.org",
            "affiliation": "N",
            "endpointDescription": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "18425 W West Creek Dr",
            "address_2": "Ste F",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604776767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.