Dermatology Center of Southern Indiana, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

DERMATOLOGY CENTER OF SOUTHERN INDIANA, P.C.

Practice address

1200 S Rogers St
Bloomington, IN 47403-4792

Phone

(812) 339-6434

Fax

(812) 331-0196

NPI assigned

Oct 16, 2006

Last updated

Apr 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Kathleen McTigue, M.D.NPI 1578567343

Title

President

Phone

(812) 339-6434

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Mary Kathleen McTigue, M.D.

  • Dermatology Physician
  • Bloomington, IN
  • NPI 1578567343
  Medicare reassignment Care Compare group NPD Authorized official
• Michelle Gita Baechtold, MD

  • Dermatology Physician
  • Bloomington, IN
  • NPI 1669867669
  Medicare reassignment Care Compare group NPD
• Eran V Chen, M.D.

  • Dermatology Physician
  • Bloomington, IN
  • NPI 1700229077
  Medicare reassignment Care Compare group NPD
• Carrie Lynn Davis, M.D.

  • Dermatology Physician
  • Bloomington, IN
  • NPI 1801063128
  Medicare reassignment Care Compare group NPD
• Molly Bridget Kitley, MD

  • Dermatology Physician
  • Bloomington, IN
  • NPI 1720578131
  Medicare reassignment Care Compare group NPD
• Madison Elizabeth McNeely, PA-C

  • Physician Assistant
  • Bloomington, IN
  • NPI 1114807211
  Medicare reassignment Care Compare group NPD
• Staci C Murphy, FNP, PNP

  • Nurse Practitioner
  • Bloomington, IN
  • NPI 1235155722
  Medicare reassignment Care Compare group NPD
• Roxanne Rajaii, D.O.

  • Dermatology Physician
  • Bloomington, IN
  • NPI 1184000531
  Medicare reassignment Care Compare group NPD
• Claudia Irene Vidal, MD

  • Dermatopathology (Pathology) Physician
  • Bloomington, IN
  • NPI 1790944742
  Medicare reassignment Care Compare group NPD
• Talley Bhanyang Whang, M.D.

  • Dermatology Physician
  • Bloomington, IN
  • NPI 1689846909
  Medicare reassignment Care Compare group NPD
• Natalie Harrell, PA-C

  • Physician Assistant
  • Bloomington, IN
  • NPI 1578392916
  Medicare reassignment Care Compare group
• William T Havens, PA

  • Medical Physician Assistant
  • Bloomington, IN
  • NPI 1831182898
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1659451755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034792",
            "telephone_number": "812-339-6434",
            "fax_number": "812-331-0196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034792",
            "telephone_number": "812-339-6434",
            "fax_number": "812-331-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER OF SOUTHERN INDIANA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "MCTIGUE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHLEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-339-6434",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100182850",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Hope Denson
• Dental Care Action Inc (Dental Care Center)
• Dental Health Assoc of in (Ellettsville Gentle Dentist)
• Dental Health Associates of Indiana
• Dental Professionals of Indiana, P.C. (Southern Indiana Smiles)
• Amanda M Deschepper, PHARMD
• Gene Devane, D.P.M.
• Brittany Devine
• Kayla A Devito, MSW, LCSW
• Doreen Dotlich Devitt

• Specialist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; 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.