Active NPI
Carrie Lynn Davis, M.D.
- Dermatology Physician
- Bloomington, IN
National Provider Identifier
1801063128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 01064872A
- Practice address
- 1200 S Rogers St
Bloomington, IN 47403-4792 - Phone
- (812) 339-6434
- Fax
- (812) 331-0196
- NPI assigned
- May 15, 2008
- Last updated
- Mar 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 01064872A | IN | Primary |
| Procedural Dermatology Physician | 207NS0135X | 01064872A | IN |
Addresses
Primary practice location
1200 S Rogers St
Bloomington, IN 47403-4792
Mailing address
1200 S Rogers St
Bloomington, IN 47403-4792
Phone (812) 339-6434
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200903360A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Indiana University School of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1200 S Rogers St
Bloomington, IN 47403-4792
Phone (812) 339-6434
Hospital & facility affiliations
- Indiana University Health Bloomington Hospital
- Indiana University Health
- Greene County General Hospital
- Indiana University Health Bedford Hospital
- Indiana University Health Paoli Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.28 of 100
- Quality
- 73.79
- Promoting interoperability
- 99
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 12 |
| Removal of tissue | 1-10 |
| Removal of skin lesions | 2005 |
| Removal or shaving of skin growth | 134 |
| Skin biopsy | 482 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01064872A | IN | MD | Procedural Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology Center of Southern Indiana, P.C. | Current | Accepting new patients |
Locations
1200 S Rogers St
Bloomington, IN 47403
Phone (812) 339-6434
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Bloomington, IN
- NPI 1659451755
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Linton, IN
- NPI 1184695389
-
dba IU Health Bedford Hospital
- Critical Access Hospital
- Bedford, IN
- NPI 1548260284
-
dba IU Health Bedford
- Ambulance
- Bedford, IN
- NPI 1346218799
Hospital
-
dba Iu Health Bloomington
- General Acute Care Hospital
- Bloomington, IN
- NPI 1205860335
-
dba Indiana University Health
- General Acute Care Hospital
- Indianapolis, IN
- NPI 1144266024
-
dba IU Health Paoli
- Critical Access Hospital
- Paoli, IN
- NPI 1912984451
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1801063128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 S ROGERS ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474034792",
"telephone_number": "812-339-6434",
"fax_number": "812-331-0196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 S ROGERS ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474034792",
"telephone_number": "812-339-6434",
"fax_number": "812-331-0196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "CARRIE",
"middle_name": "LYNN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-15",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "IN",
"license": "01064872A",
"primary": true
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "IN",
"license": "01064872A",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200903360A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.