NPIMap

Organization Active NPI

PV Bay State LLC

Doing business as Pioneer Valley Dermatology PC

  • Dermatology Physician
  • Amherst, MA
National Provider Identifier
1700698222
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PV BAY STATE LLC
Doing business as
Pioneer Valley Dermatology PC
Practice address
29 Cottage St Ste B
Amherst, MA 01002-2181
Phone
(413) 849-7400
Fax
(413) 549-7402
NPI assigned
Jan 22, 2025
Last updated
Jan 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Samuel Goos, MDNPI 1548240039
Title
Managing Partner
Phone
(978) 371-7010

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

29 Cottage St Ste B
Amherst, MA 01002-2181

Mailing address

526 Main St Ste 302
Acton, MA 01720-3301
Phone (978) 371-7010

Other names 1

  • Pioneer Valley Dermatology PC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250326002487 MA Part B Supplier - Clinic/Group Practice 1951824358 Receives reassigned benefits from 1 practitioner
Practice locations: Amherst, MA

National Provider Directory

National Provider Directory

Locations

29 Cottage St
Ste B
Amherst, MA 01002
Phone (413) 549-7400

Practitioners & affiliated clinicians

Practitioners 9

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": "1737504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1700698222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 MAIN ST STE 302",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017203301",
            "telephone_number": "978-371-7010",
            "fax_number": "978-371-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 COTTAGE ST STE B",
            "city": "AMHERST",
            "state": "MA",
            "postal_code": "010022181",
            "telephone_number": "413-849-7400",
            "fax_number": "413-549-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PV BAY STATE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "GOOS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "978-371-7010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pioneer Valley Dermatology PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amherst, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.