Surgical & Cosmetic Dermatology of Rhode Island, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

MD10753 Issued in RI

Legal business name

SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC

Practice address

1 Randall SQ
Suite 306
Providence, RI 02904-2709

Phone

(401) 751-7546

Fax

(401) 751-6888

NPI assigned

Sep 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Marina Kuperman-Beade, M.D.NPI 1477572816

Title

Owner

Phone

(401) 751-7546

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in RI, MA2 enrollments

Enrollment records 2

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/AFBBBA

Practitioners 6

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

• Marina Kuperman-Beade, M.D., F.A.A.D.

  • MOHS-Micrographic Surgery Physician
  • Fall River, MA
  • NPI 1477572816

  RI

  Medicare reassignment Care Compare group NPD Authorized official
• Jeffrey M Soares, PA-C

  • Physician Assistant
  • Fall River, MA
  • NPI 1366773202
  Medicare reassignment Care Compare group NPD
• Graciette Da Silva, PA-C

  • Physician Assistant
  • Providence, RI
  • NPI 1144221862

  MA

  Medicare reassignment Care Compare group
• Nonna Khachiyan, PA-C

  • Physician Assistant
  • Fall River, MA
  • NPI 1073677498
  Medicare reassignment
• Kristin Alberti, N.P.

  • Nurse Practitioner
  • Fall River, MA
  • NPI 1255616330
  NPD (past)
• Erik Domingues, MD

  • Dermatology Physician
  • Fall River, MA
  • NPI 1962713370
  NPD (past)

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1770770547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ",
            "address_2": "SUITE 306",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042709",
            "telephone_number": "401-751-7546",
            "fax_number": "401-751-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ",
            "address_2": "SUITE 306",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042709",
            "telephone_number": "401-751-7546",
            "fax_number": "401-751-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL & COSMETIC DERMATOLOGY OF RHODE ISLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "KUPERMAN-BEADE",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-751-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "RI",
            "license": "MD10753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD6437",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9003758",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunrise Adhc LLC
• Sunshine Pediatrics LLC
• Jared Sears Supple, MD
• Supportive Care I of Rhode Island PC
• Kristina Sura, MD
• Tinatin Surguladze, DH.D.
• Michelle Elizabeth Suriani, MS, RD
• Cindy Surin
• Claire Surkis
• Ghulam Mustafa Surti, MD

• MOHS-Micrographic Surgery Physician in Providence, RI
• Providers in Providence, RI by specialty
• MOHS-Micrographic Surgery Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.