NPIMap

Organization Active NPI

Owensboro Dermatology Associates, PSC

  • Dermatology Physician
  • Owensboro, KY
National Provider Identifier
1821130295
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
OWENSBORO DERMATOLOGY ASSOCIATES, PSC
Practice address
2821 New Hartford Rd
Owensboro, KY 42303-1320
Phone
(270) 685-5777
Fax
(270) 685-0190
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

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

Authorized official

Name
Julia Alvey
Title
Credentialing
Phone
(270) 852-3893

Specialties & licenses 1

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

Addresses

Primary practice location

2821 New Hartford Rd
Owensboro, KY 42303-1320

Mailing address

2821 New Hartford Rd
Owensboro, KY 42303-1320
Phone (270) 685-5777

Other identifiers 1

IdentifierTypeStateIssuer
6592778200MedicaidKY

Other names 1

  • Henderson Dermatology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041014000755 KY Part B Supplier - Clinic/Group Practice 0547220402 Receives reassigned benefits from 10 practitioners
Practice locations: Henderson, KY; Owensboro, KY
O20210401001668 IN Part B Supplier - Clinic/Group Practice 0547220402 Receives reassigned benefits from 5 practitioners
Practice locations: Newburgh, IN

National Provider Directory

National Provider Directory

Locations

1413 N Elm St
Ste 202
Henderson, KY 42420
Phone 27068557774791

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749081600000",
    "number": "1821130295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 NEW HARTFORD RD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031320",
            "telephone_number": "270-685-5777",
            "fax_number": "270-685-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 NEW HARTFORD RD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031320",
            "telephone_number": "270-685-5777",
            "fax_number": "270-685-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWENSBORO DERMATOLOGY ASSOCIATES, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A",
        "authorized_official_last_name": "ALVEY",
        "authorized_official_first_name": "JULIA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "270-852-3893"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6592778200",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henderson Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Owensboro, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; 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.