Blue Ridge Dermatology PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BLUE RIDGE DERMATOLOGY PA

Practice address

540 Hospital Dr
Clyde, NC 28721-8027

Phone

(828) 456-7343

Fax

(828) 452-0939

NPI assigned

Sep 19, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Jason Masters, MDNPI 1386639524

Title

President Treasurer

Phone

(828) 456-7343

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Jason Masters, MD

  • Dermatology Physician
  • Clyde, NC
  • NPI 1386639524
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821083551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 HOSPITAL DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287218027",
            "telephone_number": "828-456-7343",
            "fax_number": "828-452-0939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 HOSPITAL DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287218027",
            "telephone_number": "828-456-7343",
            "fax_number": "828-452-0939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MASTERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT TREASURER",
        "authorized_official_telephone_number": "828-456-7343",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0122K",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890122K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BHG Xxxvii, LLC
• Luke Bidikov
• Blue Mountain Urology, PLLC
• Blue Ridge Community Health Services, Inc (Haywood Health Center)
• Blue Ridge Community Health Services, Inc (Blue Ridge Health-Haywood Pharmacy)
• Blue Ridge Family Practice Assoc
• Blue Ridge Ultrasound, Inc.
• Bodnar & Wyatt, PLLC (Cataloochee Dental Group)
• Jason Bodnar, DMD
• Harold Breakey

• Dermatology Physician in Clyde, NC
• Providers in Clyde, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.