Integrated Skin Institute PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTEGRATED SKIN INSTITUTE PLLC

Practice address

1424 W Baddour Pkwy Ste G
Lebanon, TN 37087-2685

Phone

(615) 314-1699

Fax

(615) 622-8905

NPI assigned

Dec 18, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Tejaswi V Mudigonda, MDNPI 1891143277

Title

Ceo

Phone

(551) 208-3090

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IEAEDD

Practitioners 1

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

• Tejaswi Venkata Mudigonda, M.D.

  • MOHS-Micrographic Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1891143277

  Dermatology, TN

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712448000000",
    "number": "1770351041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 W BADDOUR PKWY STE G",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370872685",
            "telephone_number": "615-314-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 W BADDOUR PKWY STE G",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370872685",
            "telephone_number": "615-314-1699",
            "fax_number": "615-622-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED SKIN INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2024-04-07",
        "certification_date": "2024-04-07",
        "status": "A",
        "authorized_official_last_name": "MUDIGONDA",
        "authorized_official_first_name": "TEJASWI",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "551-208-3090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andreana Ngoc Huynh, OD
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• Impact Physical Therapy, LLC
• Independent Physical Therapy, LLC
• Brian Michael Inglis
• Integrity Hospitalists Group LLP
• Integrity Rehabilitation Group
• Katherine Isaacson, F.N.P.
• Jackson Medical Products, LLC
• Amanda Jackson, PHARM.D.

• Dermatology Physician in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.