NPIMap

Organization Active NPI

River Region Dermatology and Laser Inc

  • Dermatology Physician
  • Montgomery, AL
National Provider Identifier
1699128009
Registry record updated Jul 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
RIVER REGION DERMATOLOGY AND LASER INC
Practice address
2060 Berryhill Rd
Montgomery, AL 36117-8965
Phone
(334) 416-8996
Fax
(334) 416-8997
NPI assigned
Jul 20, 2016
Last updated
Jul 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2016

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

Authorized official

Name
Dr. Porcia Love, MDNPI 1326195124
Title
Sole Member Owner
Phone
(334) 416-8996

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
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

2060 Berryhill Rd
Montgomery, AL 36117-8965

Mailing address

1254 Laurel Brook LN
Montgomery, AL 36117-8965
Phone (334) 416-8996

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160811002579 AL Part B Supplier - Clinic/Group Practice 3678867736 Receives reassigned benefits from 5 practitioners
Practice locations: Montgomery, AL

National Provider Directory

National Provider Directory

Locations

2060 Berryhill Rd
Montgomery, AL 36117
Phone (334) 416-8996

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469664000000",
    "number": "1699128009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1254 LAUREL BROOK LN",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361178965",
            "telephone_number": "334-416-8996",
            "fax_number": "334-416-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 BERRYHILL RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361178965",
            "telephone_number": "334-416-8996",
            "fax_number": "334-416-8997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER REGION DERMATOLOGY AND LASER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-07-28",
        "status": "A",
        "authorized_official_last_name": "LOVE",
        "authorized_official_first_name": "PORCIA",
        "authorized_official_title_or_position": "SOLE MEMBER OWNER",
        "authorized_official_telephone_number": "334-416-8996",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; 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.