NPIMap

Organization Active NPI

Iowa Dermatology Clinic, PLC

Doing business as Radiant Complexions Dermatology Clinic

  • Dermatology Physician
  • Des Moines, IA
National Provider Identifier
1508238395
Registry record updated May 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
IOWA DERMATOLOGY CLINIC, PLC
Doing business as
Radiant Complexions Dermatology Clinic
Practice address
5921 SE 14TH St
Suite 2500
Des Moines, IA 50320-1746
Phone
(515) 287-5757
Fax
(515) 287-0063
NPI assigned
Oct 20, 2015
Last updated
May 2, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
IOWA DERMATOLOGY CLINIC, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2016

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

Authorized official

Name
Andrew B Karas, MBA
Title
Cfo
Phone
(515) 226-3116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

5921 SE 14TH St
Suite 2500
Des Moines, IA 50320-1746

Mailing address

5921 SE 14TH St
Suite 2500
Des Moines, IA 50320-1746
Phone (515) 287-5757

Other names 1

  • Radiant Complexions Dermatology Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000335 IA Part B Supplier - Clinic/Group Practice 2961394713 Receives reassigned benefits from 25 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshalltown, IA; Cedar Rapids, IA; Mason City, IA; Norwalk, IA; Storm Lake, IA; Urbandale, IA; West Des Moines, IA; Grinnell, IA…

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Part of
Iowa Dermatology Clinic PLC

Locations

5921 SE 14th St
Ste 2500
Des Moines, IA 50320
Phone (515) 287-5757

NPI Registry JSON

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

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462147200000",
    "number": "1508238395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5921 SE 14TH ST",
            "address_2": "SUITE 2500",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503201746",
            "telephone_number": "515-287-5757",
            "fax_number": "515-287-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5921 SE 14TH ST",
            "address_2": "SUITE 2500",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503201746",
            "telephone_number": "515-287-5757",
            "fax_number": "515-287-0063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA DERMATOLOGY CLINIC, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IOWA DERMATOLOGY CLINIC, PLC",
        "enumeration_date": "2015-10-20",
        "last_updated": "2016-05-02",
        "status": "A",
        "authorized_official_last_name": "KARAS",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "515-226-3116",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Complexions Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2016; 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.