NPIMap

Organization Active NPI

Advanced Dermatology & Skin Care Specialists, LLC

  • Dermatology Physician
  • Oxford, AL
National Provider Identifier
1801969480
Registry record updated Jun 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
0023813 Issued in AL
Legal business name
ADVANCED DERMATOLOGY & SKIN CARE SPECIALISTS, LLC
Practice address
1419 Hamric Dr E
Suite 101
Oxford, AL 36203-1933
Phone
(256) 235-3660
Fax
(256) 235-3663
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2012

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

Authorized official

Name
Dr. Shelley H Ray, M.D.
Title
MD Owner
Phone
(256) 235-3660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 0023813 AL Primary

Addresses

Primary practice location

1419 Hamric Dr E
Suite 101
Oxford, AL 36203-1933

Mailing address

1419 Hamric Dr E
Suite 101
Oxford, AL 36203-1933
Phone (256) 235-3660

Other identifiers 4

IdentifierTypeStateIssuer
529908960MedicaidAL
51503704OtherALBC BS ALABAMA DR RAY
051556655MedicaidAL
0051503704MedicaidAL

National Provider Directory

National Provider Directory

Locations

1419 Hamric Dr E
Ste 101
Oxford, AL 36203
Phone (256) 235-3660

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BFICAA

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339632000000",
    "number": "1801969480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 HAMRIC DR E",
            "address_2": "SUITE 101",
            "city": "OXFORD",
            "state": "AL",
            "postal_code": "362031933",
            "telephone_number": "256-235-3660",
            "fax_number": "256-235-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 HAMRIC DR E",
            "address_2": "SUITE 101",
            "city": "OXFORD",
            "state": "AL",
            "postal_code": "362031933",
            "telephone_number": "256-235-3660",
            "fax_number": "256-235-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY & SKIN CARE SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2012-06-14",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "256-235-3660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AL",
            "license": "0023813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529908960",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS ALABAMA DR RAY",
            "identifier": "51503704",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051556655",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051503704",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oxford, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.