NPIMap

Organization Active NPI

Pinnacle Dermatology, SC

  • Dermatology Physician
  • Plymouth, MN
National Provider Identifier
1609009380
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PINNACLE DERMATOLOGY, SC
Practice address
3655 Plymouth Blvd
Suite 110
Plymouth, MN 55446-3664
Phone
(612) 486-4200
Fax
(612) 486-4201
NPI assigned
Aug 28, 2009
Organization subpart
Yes
Parent organization
PINNACLE DERMATOLOGY, SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Authorized official

Name
Paula Lapinski, M.D.NPI 1437262482
Title
President
Phone
(815) 744-8554

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

3655 Plymouth Blvd
Suite 110
Plymouth, MN 55446-3664

Mailing address

5141 Virginia Way
Ste 350
Brentwood, TN 37027
Phone (629) 666-2462

Other identifiers 1

IdentifierTypeStateIssuer
059266800MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091102000251 MN Part B Supplier - Clinic/Group Practice 1658418181 Receives reassigned benefits from 14 practitioners
Practice locations: Blaine, MN; Burnsville, MN; Crystal, MN; Edina, MN; Excelsior, MN; Plymouth, MN; Woodbury, MN

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
24D1105247Pinnacle Dermatology - Plymouth3655 Plymouth Blvd, Suite 110, Plymouth, MN 55446ComplianceJun 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pinnacle Dermatolgy SC32 organizations share this tax ID, including this one
Part of
Pinnacle Dermatolgy SC

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

2805 Campus Dr
Ste 255
Plymouth, MN 55441
Phone (612) 486-4200

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1609009380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5141 VIRGINIA WAY",
            "address_2": "STE 350",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "37027",
            "telephone_number": "629-666-2462",
            "fax_number": "629-666-2462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 PLYMOUTH BLVD",
            "address_2": "SUITE 110",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463664",
            "telephone_number": "612-486-4200",
            "fax_number": "612-486-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE DERMATOLOGY, SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINNACLE DERMATOLOGY, SC",
        "enumeration_date": "2009-08-28",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "LAPINSKI",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-744-8554",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "059266800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

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