Active NPI
Blue Ridge Dermatology Associates
- Dermatology Physician
- Raleigh, NC
National Provider Identifier
1770545550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- BLUE RIDGE DERMATOLOGY ASSOCIATES
- Practice address
- 4225 Macon Pond Rd Ste 300
Raleigh, NC 27607-6320 - Phone
- (919) 781-1050
- Fax
- (919) 510-5090
- NPI assigned
- Apr 5, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lynda A Amsden
- Title
- Credentialing Coordinator
- Phone
- (919) 781-1050
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
4225 Macon Pond Rd Ste 300
Raleigh, NC 27607-6320
Mailing address
4225 Macon Pond Rd Ste 300
Raleigh, NC 27607-6320
Phone (919) 781-1050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8901073 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040825001469 | NC | Part B Supplier - Clinic/Group Practice | 7618941444 |
Receives reassigned benefits from 17 practitioners Practice locations: Raleigh, NC; Cary, NC |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2312042 | Blue Ridge Dermatology Associates, PA | Compliance | Aug 7, 2027 |
National Provider Directory
National Provider DirectoryLocations
3225 Blue Ridge Rd
Ste 101
Raleigh, NC 27612
Phone (919) 781-1050
4225 Macon Pond Rd
Raleigh, NC 27607
Phone (919) 205-2505
4225 Macon Pond Rd
Ste 300
Raleigh, NC 27607
Phone (919) 781-1050
Practitioners & affiliated clinicians
Practitioners 24
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- MOHS-Micrographic Surgery Physician
- Cary, NC
- NPI 1154302610
Dermatology, NC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144195200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1736208000000",
"number": "1770545550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4225 MACON POND RD STE 300",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076320",
"telephone_number": "919-781-1050",
"fax_number": "919-510-5090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4225 MACON POND RD STE 300",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076320",
"telephone_number": "919-781-1050",
"fax_number": "919-510-5090"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLUE RIDGE DERMATOLOGY ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-05",
"last_updated": "2025-01-07",
"certification_date": "2025-01-07",
"status": "A",
"authorized_official_last_name": "AMSDEN",
"authorized_official_first_name": "LYNDA",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
"authorized_official_telephone_number": "919-781-1050"
},
"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": "8901073",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.