NPIMap

Organization Active NPI

Parker Skin & Aesthetic Clinic Inc.

  • Procedural Dermatology Physician
  • Beachwood, OH
National Provider Identifier
1609894575
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
35-058810 Issued in OH
Legal business name
PARKER SKIN & AESTHETIC CLINIC INC.
Practice address
3733 Park East Dr
Suite #104
Beachwood, OH 44122-4338
Phone
(216) 464-7333
Fax
(216) 464-2696
NPI assigned
Jul 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Dr. Lydia Parker, MDNPI 1912937079
Title
President
Phone
(216) 464-7333

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
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X 35-058810 OH Primary

Addresses

Primary practice location

3733 Park East Dr
Suite #104
Beachwood, OH 44122-4338

Mailing address

3737 Park East Dr Ste 109
Beachwood, OH 44122-4329
Phone (216) 464-7333

Other identifiers 1

IdentifierTypeStateIssuer
2081509MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050125000580 OH Part B Supplier - Clinic/Group Practice 4587614813 Receives reassigned benefits from 15 practitioners
Practice locations: Beachwood, OH; Westlake, OH; Willoughby, OH

National Provider Directory

National Provider Directory

Locations

3733 Park East Dr
Ste 109
Beachwood, OH 44122

3737 Park East Dr
Beachwood, OH 44122

3737 Park East Dr
Ste 109
Beachwood, OH 44122
Phone (216) 464-7333

2001 Crocker Rd
Ste 150
Westlake, OH 44145
Phone (440) 235-8484

4212 State Route 306
Ste 200
Willoughby, OH 44094
Phone (216) 831-6550

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1609894575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 PARK EAST DR STE 109",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224329",
            "telephone_number": "216-464-7333",
            "fax_number": "216-342-5462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3733 PARK EAST DR",
            "address_2": "SUITE #104",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224338",
            "telephone_number": "216-464-7333",
            "fax_number": "216-464-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKER SKIN & AESTHETIC CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-464-7333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OH",
            "license": "35-058810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2081509",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beachwood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.