NPIMap

Organization Active NPI

The Dermatology Clinic PA

  • Dermatology Physician
  • Hot Springs, AR
National Provider Identifier
1720611635
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
THE DERMATOLOGY CLINIC PA
Practice address
1710 Malvern Ave
Hot Springs, AR 71901-7132
Phone
(501) 623-6100
Fax
(501) 623-3403
NPI assigned
Feb 19, 2020
Organization subpart
Yes
Parent organization
THE DERMATOLOGY CLINIC PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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

Authorized official

Name
Mr. Adam S Stibich, MDNPI 1093715047
Title
Owner/ Provider/ Physician
Phone
(501) 623-6100

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

1710 Malvern Ave
Hot Springs, AR 71901-7132

Mailing address

3633 Central Ave Ste N
Hot Springs, AR 71913-6475
Phone (501) 623-6100

Other identifiers 1

IdentifierTypeStateIssuer
120956002MedicaidAR

Other names 1

  • The Dermatology Clinic PA-Malvern Ave Clinic Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2126494Dermatology Clinic, the1710 Malvern Avenue, Hot Springs, AR 71901Provider-performed microscopyFeb 27, 2027

National Provider Directory

National Provider Directory
Part of
Stough Clinic

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1720611635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 CENTRAL AVE STE N",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136475",
            "telephone_number": "501-623-6100",
            "fax_number": "501-623-3403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 MALVERN AVE",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719017132",
            "telephone_number": "501-623-6100",
            "fax_number": "501-623-3403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DERMATOLOGY CLINIC PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE DERMATOLOGY CLINIC PA",
        "enumeration_date": "2020-02-19",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "STIBICH",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/ PROVIDER/ PHYSICIAN",
        "authorized_official_telephone_number": "501-623-6100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120956002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dermatology Clinic PA-Malvern Ave Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hot Springs, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.