NPIMap

Organization Active NPI

Dermatology Clinic PC

  • Dermatology Physician
  • Salem, OR
National Provider Identifier
1831150846
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY CLINIC PC
Practice address
2441 Grear St NE
Salem, OR 97301-2749
Phone
(503) 364-3321
NPI assigned
Mar 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Authorized official

Name
Carolyn Greenwade
Title
Office Manager
Phone
(503) 588-0469

Specialties & licenses 1

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

Addresses

Primary practice location

2441 Grear St NE
Salem, OR 97301-2749

Mailing address

2441 Grear St NE
Salem, OR 97301-2749
Phone (503) 364-3321

Other identifiers 1

IdentifierTypeStateIssuer
046573MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421001188 OR Part B Supplier - Clinic/Group Practice 3577559012 Receives reassigned benefits from 17 practitioners
Practice locations: Salem, OR

National Provider Directory

National Provider Directory

Locations

5900 Inland Shores Way N
Ste 202
Keizer, OR 97303
Phone (503) 463-6799

2441 Grear St NE
Salem, OR 97301
Phone (503) 364-3321

2521 Boone Rd SE
Ste 140
Salem, OR 97306

8840 SW Citizens Dr
Wilsonville, OR 97070
Phone (503) 364-2150

8642 SW Main St
Ste 100
Wilsonville, OR 97070
Phone (503) 463-6799

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1831150846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2441 GREAR ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012749",
            "telephone_number": "503-364-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2441 GREAR ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012749",
            "telephone_number": "503-364-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "GREENWADE",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-588-0469"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046573",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; 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.