NPIMap

Organization Active NPI

D. Neal Mastruserio, M.D., LLC

  • Procedural Dermatology Physician
  • Columbus, OH
National Provider Identifier
1750570453
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
35072392M Issued in OH
Legal business name
D. NEAL MASTRUSERIO, M.D., LLC
Practice address
3380 Tremont Rd Ste 140
Columbus, OH 43221-2140
Phone
(614) 442-6647
Fax
(614) 442-6648
NPI assigned
Oct 18, 2007
Last updated
Dec 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Authorized official

Name
Dr. Dominic Neal Mastruserio, MDNPI 1508818386
Title
President
Phone
(614) 442-6647

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
Procedural Dermatology Physician 207NS0135X 35072392M OH Primary

Addresses

Primary practice location

3380 Tremont Rd Ste 140
Columbus, OH 43221-2140

Mailing address

3380 Tremont Rd Ste 140
Columbus, OH 43221-2140
Phone (614) 442-6647

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071120000095 OH Part B Supplier - Clinic/Group Practice 4789772013 Receives reassigned benefits from 3 practitioners
Practice locations: Columbus, OH

National Provider Directory

National Provider Directory

Locations

941 Chatham Ln
Ste 323
Columbus, OH 43221
Phone (614) 442-6647

Practitioners & affiliated clinicians

Practitioners 3

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": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1750570453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 TREMONT RD STE 140",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432212140",
            "telephone_number": "614-442-6647",
            "fax_number": "614-442-6648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 TREMONT RD STE 140",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432212140",
            "telephone_number": "614-442-6647",
            "fax_number": "614-442-6648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D. NEAL MASTRUSERIO, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "MASTRUSERIO",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_middle_name": "NEAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-442-6647",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OH",
            "license": "35072392M",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.