Dermatology at Midtowne, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY AT MIDTOWNE, PC

Practice address

555 Midtowne St NE
Suite 301
Grand Rapids, MI 49503-5729

Phone

(616) 248-8864

Fax

(616) 248-8874

NPI assigned

Sep 9, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Dipa Suman Patel, MDNPI 1205836962

Title

Physician/Owner

Phone

(616) 248-8864

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Practitioners 3

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

• Dipa Suman Patel, MD

  • Dermatology Physician
  • Grand Rapids, MI
  • NPI 1205836962
  Medicare reassignment Care Compare group Authorized official
• Paige Eleanora Pitynski, PA-C

  • Dermatology Physician
  • Grand Rapids, MI
  • NPI 1407695000
  Medicare reassignment Care Compare group
• Leeann Marie Kuehn, PA-C, MPH

  • Physician Assistant
  • Grand Rapids, MI
  • NPI 1124688197
  Medicare reassignment

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

{
    "created_epoch": "1347148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1780933432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 MIDTOWNE ST NE STE 301",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035729",
            "telephone_number": "616-248-8864",
            "fax_number": "616-248-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 MIDTOWNE ST NE",
            "address_2": "SUITE 301",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035729",
            "telephone_number": "616-248-8864",
            "fax_number": "616-248-8874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AT MIDTOWNE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-09",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "DIPA",
        "authorized_official_middle_name": "SUMAN",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "616-248-8864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Michael Deridder, PHARM.D
• Hannah Deritter
• Leah Deritter
• Kaitlin Derks, NP
• Layne Derks, PA-C
• Dermatology Center of Grand Rapids PC
• Dermatology Specialists of Grand Rapids, PLLC
• James Dernocoeur, PA
• Heidi Ruth Deroo, LMSW
• Katie Deroo, D.P.T.

• Dermatology Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.