NPIMap

Organization Active NPI

Southeastern Skin Cancer & Dermatology

  • MOHS-Micrographic Surgery Physician
  • Madison, AL
National Provider Identifier
1538433602
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
DO987 Issued in AL
Legal business name
SOUTHEASTERN SKIN CANCER & DERMATOLOGY
Practice address
104 J E Briscoe Way
Madison, AL 35758-4822
Phone
(256) 705-3000
Fax
(256) 705-3105
NPI assigned
Mar 6, 2012
Last updated
Aug 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Authorized official

Name
Dr. Albert E Rivera, D.O.NPI 1366583882
Title
President
Phone
(859) 351-4994

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X DO987 AL Primary

Addresses

Primary practice location

104 J E Briscoe Way
Madison, AL 35758-4822

Mailing address

124 County Road 3401
Haleyville, AL 35565-6959

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120823000122 AL Part B Supplier - Clinic/Group Practice 0648427856 Receives reassigned benefits from 9 practitioners
Practice locations: Madison, AL

National Provider Directory

National Provider Directory

Locations

104 J E Briscoe Way
Madison, AL 35758
Phone (256) 705-3000

Practitioners & affiliated clinicians

Practitioners 9

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": "1330992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1538433602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 COUNTY ROAD 3401",
            "city": "HALEYVILLE",
            "state": "AL",
            "postal_code": "355656959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 J E BRISCOE WAY",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357584822",
            "telephone_number": "256-705-3000",
            "fax_number": "256-705-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN SKIN CANCER & DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-06",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-351-4994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AL",
            "license": "DO987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.