Dermatology Associates of Indy LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY ASSOCIATES OF INDY LLC

Practice address

1700 W Smith Valley Rd
Ste. B
Greenwood, IN 46142-1599

Phone

(855) 492-6333

Fax

(918) 493-9405

NPI assigned

Aug 17, 2015

Organization subpart

No

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

Authorized official

Name

Robert Nevin

Title

Managing Partner

Phone

(855) 492-6333

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Dermatology Associates of Indy LLC

  • Dermatology Physician
  • Evansville, IN
  • NPI 1962808774

  O20150312002083

  Same enrollment

Locations

Practitioners 4

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

• Vanessa M Mischler, NP

  • Nurse Practitioner
  • Evansville, IN
  • NPI 1104508993

  Dermatology

  NPD
• Cole David Lundquist, MD

  • Dermatology Physician
  • Park Ridge, IL
  • NPI 1982688891
  NPD
• Alexandria Anderson, MSN, FNP-C

  • Family Nurse Practitioner
  • Evansville, IN
  • NPI 1881530582
  NPD (past)
• Stephen Edward Mahoney, M.D.

  • Specialist
  • Houston, TX
  • NPI 1295743490
  NPD (past)

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439769600000",
    "number": "1770959520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6966 S UTICA AVE",
            "address_2": "STE. 225",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363903",
            "telephone_number": "855-492-6333",
            "fax_number": "918-493-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W SMITH VALLEY RD",
            "address_2": "STE. B",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461421599",
            "telephone_number": "855-492-6333",
            "fax_number": "918-493-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF INDY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-08-17",
        "status": "A",
        "authorized_official_last_name": "NEVIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "855-492-6333"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals of Indiana, P.C.
• Dental Professionals of Indiana, P.C.
• Dental Professionals of Indiana, P.C.
• Julie Denton, NP
• Dentsmart
• Dermatology Center of Indiana PC
• Dermatology Inc
• Jennifer Derocher, BCBA
• Kena Desai, PHARMD
• Mona P Desai, MD

• Dermatology Physician in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; 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.