NPIMap

Organization Active NPI

Pinnacle Dermatology, S.C.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Wayzata, MN
National Provider Identifier
1720814429
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
Legal business name
PINNACLE DERMATOLOGY, S.C.
Practice address
935 Wayzata Blvd E Ste 200
Wayzata, MN 55391-2513
Phone
(763) 220-8030
NPI assigned
Sep 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Authorized official

Name
Jose Luis Rios, MD
Title
Vice President
Phone
(815) 744-8554

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0905X Primary
Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0122X

Addresses

Primary practice location

935 Wayzata Blvd E Ste 200
Wayzata, MN 55391-2513

Mailing address

PO Box 734240
Chicago, IL 60673-4240

National Provider Directory

National Provider Directory
Tax ID family
Pinnacle Dermatolgy SC32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

935 Wayzata Blvd E
Ste 200
Wayzata, MN 55391
Phone (763) 220-8030

NPI Registry JSON

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

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1720814429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734240",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606734240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 WAYZATA BLVD E STE 200",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553912513",
            "telephone_number": "763-220-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "RIOS",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "815-744-8554",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayzata, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.