NPIMap

Organization Active NPI

Iowa Dermatology Clinic PLC

Doing business as Radiant Complexions Dermatology Clinic

  • Dermatology Physician
  • Fort Dodge, IA
National Provider Identifier
1679062848
Registry record updated May 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
IOWA DERMATOLOGY CLINIC PLC
Doing business as
Radiant Complexions Dermatology Clinic
Practice address
22 N 27TH St
Fort Dodge, IA 50501-4331
Phone
(515) 955-4440
NPI assigned
May 3, 2018
Last updated
May 3, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
IOWA DERMATOLOGY CLINIC PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 3, 2018

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

Authorized official

Name
Mr. Matthew David Schemmel
Title
Vice President
Phone
(515) 226-3116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

22 N 27TH St
Fort Dodge, IA 50501-4331

Mailing address

6800 Lake Dr Ste 350
West Des Moines, IA 50266-2500
Phone (515) 226-3116

Other names 1

  • Radiant Complexions Dermatology Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000335 IA Part B Supplier - Clinic/Group Practice 2961394713 Receives reassigned benefits from 25 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshalltown, IA; Cedar Rapids, IA; Mason City, IA; Norwalk, IA; Storm Lake, IA; Urbandale, IA; West Des Moines, IA; Grinnell, IA…

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Part of
Iowa Dermatology Clinic PLC

Locations

22 N 27th St
Fort Dodge, IA 50501
Phone (515) 955-4440

6800 Lake Dr
Ste 350
West Des Moines, IA 50266

NPI Registry JSON

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525305600000",
    "number": "1679062848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 LAKE DR STE 350",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502662500",
            "telephone_number": "515-226-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 N 27TH ST",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505014331",
            "telephone_number": "515-955-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA DERMATOLOGY CLINIC PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IOWA DERMATOLOGY CLINIC PLC",
        "enumeration_date": "2018-05-03",
        "last_updated": "2018-05-03",
        "status": "A",
        "authorized_official_last_name": "SCHEMMEL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "515-226-3116",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Complexions Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Dodge, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; 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.