NPIMap

Organization Active NPI

Northern Indiana Dermatology and Skin Surgery Center

  • MOHS-Micrographic Surgery Physician
  • Portage, IN
National Provider Identifier
1639289093
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
207N00000X Issued in IN
Legal business name
NORTHERN INDIANA DERMATOLOGY AND SKIN SURGERY CENTER
Practice address
3190 Lancer St
Portage, IN 46368-4488
Phone
(219) 764-3600
Fax
(219) 764-3661
NPI assigned
Aug 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ruchik S DesaiNPI 1710975255
Title
Physician
Phone
(219) 764-3600

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 207N00000X IN Primary

Addresses

Primary practice location

3190 Lancer St
Portage, IN 46368-4488

Mailing address

3190 Lancer St
Portage, IN 46368-4488
Phone (219) 764-3600

Other identifiers 1

IdentifierTypeStateIssuer
000000350979OtherINANTHEM

National Provider Directory

National Provider Directory

Locations

3190 Lancer St
#A
Portage, IN 46368
Phone (219) 764-3600

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639289093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 LANCER ST",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684488",
            "telephone_number": "219-764-3600",
            "fax_number": "219-764-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 LANCER ST",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684488",
            "telephone_number": "219-764-3600",
            "fax_number": "219-764-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN INDIANA DERMATOLOGY AND SKIN SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "RUCHIK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "219-764-3600",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IN",
            "license": "207N00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000350979",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.