Blue Ash Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BLUE ASH DERMATOLOGY, LLC

Practice address

9403 Kenwood Rd
Ste B100
Blue Ash, OH 45242-6895

Phone

(513) 891-8045

Fax

(513) 891-8110

NPI assigned

Nov 22, 2016

Organization subpart

No

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

Authorized official

Name

Samir B Patel, MD

Title

Owner

Phone

(513) 770-4212

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495584000000",
    "number": "1679016745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9403 KENWOOD RD",
            "address_2": "STE B100",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426895",
            "telephone_number": "513-891-8045",
            "fax_number": "513-891-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9403 KENWOOD RD",
            "address_2": "STE B100",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426895",
            "telephone_number": "513-891-8045",
            "fax_number": "513-891-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ASH DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-22",
        "last_updated": "2017-05-24",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SAMIR",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-770-4212",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0209139",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory M Blakley
• Arlinda Blankumsee, LPC
• Arin Blevins
• Lauren Beth Blevins
• Amada S Block
• Blue Ash Family Counseling Center
• Blue Ash Healthcare Group, Inc.
• Blue Ash Healthcare LLC
• Blue Ash Home Care, LLC
• Blue Ash Home Health, LLC

• Dermatology Physician in Blue Ash, OH
• Providers in Blue Ash, OH by specialty
• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2017; 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.