NPIMap

Organization Active NPI

South Shore Skin Center, LLC

  • Specialist
  • Plymouth, MA
National Provider Identifier
1790763159
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTH SHORE SKIN CENTER, LLC
Practice address
1 Scobee Cir
Unit 3
Plymouth, MA 02360-4887
Phone
(508) 747-0711
Fax
(508) 746-9265
NPI assigned
Jan 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

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

Authorized official

Name
Dr. Richard F Eisen, M.D.
Title
Manager
Phone
(508) 747-0711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1 Scobee Cir
Unit 3
Plymouth, MA 02360-4887

Mailing address

1 Scobee Cir
Unit 3
Plymouth, MA 02360-4887
Phone (508) 747-0711

Other identifiers 2

IdentifierTypeStateIssuer
685603OtherMATUFTS HEALTH PLAN
M17452OtherMABLUE CROSS AND BLUE SHIEL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050119000422 MA Part B Supplier - Clinic/Group Practice 9739164328 Receives reassigned benefits from 12 practitioners
Practice locations: Norwell, MA; Plymouth, MA

National Provider Directory

National Provider Directory

Locations

3 Summer St
Hingham, MA 02043
Phone (781) 749-8900

75 Washington St
Norwell, MA 02061

45 Resnik Rd
Ste 102
Plymouth, MA 02360
Phone (508) 746-4856

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1790763159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SCOBEE CIR",
            "address_2": "UNIT 3",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023604887",
            "telephone_number": "508-747-0711",
            "fax_number": "508-746-9265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SCOBEE CIR",
            "address_2": "UNIT 3",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023604887",
            "telephone_number": "508-747-0711",
            "fax_number": "508-746-9265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE SKIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-05",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "EISEN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "508-747-0711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "685603",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "M17452",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.