Organization Active NPI

Shahrooz Dermatology Center PC

  • Dermatology Physician
  • Indianapolis, IN
National Provider Identifier
1770614604
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
01036322A Issued in IN
Legal business name
SHAHROOZ DERMATOLOGY CENTER PC
Practice address
8051 S Emerson Ave
Ste 450
Indianapolis, IN 46237-8600
Phone
(317) 859-9859
Fax
(317) 859-3265
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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

Authorized official

Name
Dr. Nahid Shahrooz, MDNPI 1649272097
Title
Owner
Phone
(317) 859-9859

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 01036322A IN Primary

Addresses

Primary practice location

8051 S Emerson Ave
Ste 450
Indianapolis, IN 46237-8600

Mailing address

8051 S Emerson Ave
Ste 450
Indianapolis, IN 46237-8600
Phone (317) 859-9859

Other identifiers 2

IdentifierTypeStateIssuer
000000356359OtherINANTHEM PIN
1649272097OtherINPHYSICIAN NPI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1770614604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8051 S EMERSON AVE",
            "address_2": "STE 450",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378600",
            "telephone_number": "317-859-9859",
            "fax_number": "317-859-3265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8051 S EMERSON AVE",
            "address_2": "STE 450",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378600",
            "telephone_number": "317-859-9859",
            "fax_number": "317-859-3265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAHROOZ DERMATOLOGY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "SHAHROOZ",
        "authorized_official_first_name": "NAHID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-859-9859",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01036322A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000356359",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN NPI",
            "identifier": "1649272097",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.