NPIMap

Organization Active NPI

Optima Dermatology LLC

  • Dermatology Physician
  • Boardman, OH
National Provider Identifier
1831187764
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
OPTIMA DERMATOLOGY LLC
Practice address
987 Boardman Canfield Rd
Boardman, OH 44512-4222
Phone
(330) 965-8760
Fax
(330) 965-9325
NPI assigned
Oct 13, 2005
Last updated
Jul 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Authorized official

Name
John Bernat, MDNPI 1215923115
Title
Authorized Official
Phone
(330) 965-8760

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Dermatopathology Physician 207ND0900X NU
Anatomic Pathology Physician 207ZP0101X NU

Addresses

Primary practice location

987 Boardman Canfield Rd
Boardman, OH 44512-4222

Mailing address

111 New Hampshire Ave Ste 2
Portsmouth, NH 03801-2864
Phone (802) 909-2053

Other practice location 1

1 Hampton Rd Unit A306
Exeter, NH 03833-4848
Phone (603) 942-2171

Other practice location 2

71 US Route 1 Ste J
Scarborough, ME 04074-7168
Phone (207) 464-2712

Other practice location 3

31 Stiles Rd Ste 2100
Salem, NH 03079-3035
Phone (603) 942-2020

Other practice location 4

5817 Happy Hollow Rd
Milford, OH 45150-1848
Phone (513) 327-9244

Other practice location 5

2223 Niles Cortland Rd SE
Warren, OH 44484-3043
Phone (330) 965-8760

Other practice location 6

8183 Golden Link Blvd
Macedonia, OH 44067
Phone (330) 778-1278

Other practice location 7

321 Niles Cortland Rd NE # Uniteb
Warren, OH 44484-1974
Phone (330) 800-5963

Other practice location 8

2525 E State St
Salem, OH 44460-9303
Phone (330) 271-8614

Other practice location 9

111 New Hampshire Ave Ste 3
Portsmouth, NH 03801-2864
Phone (603) 988-0951

Other practice location 10

7676 Reynolds Rd
Mentor, OH 44060-5110
Phone (440) 283-3015

Other practice location 11

1039 Boardman Canfield Rd
Boardman, OH 44512-4228
Phone (330) 271-8589

Other practice location 12

1027 Boardman Canfield Rd
Boardman, OH 44512-4227
Phone (330) 965-8760

Other practice location 13

911 E Aurora Rd
Macedonia, OH 44056-1905
Phone (330) 306-9844

Other practice location 14

1100 Southfield Dr Ste 1240
Plainfield, IN 46168-4499
Phone (317) 838-9911

Other practice location 15

824 Edwards Dr
Plainfield, IN 46168-2791
Phone (317) 406-3254

Other practice location 16

1010 W 2nd St
Bloomington, IN 47403-2217
Phone (812) 200-2458

Other practice location 17

2800 S State Road 135 Ste 250
Greenwood, IN 46143-6223
Phone (317) 300-1788

Other practice location 18

6639 Whitestown Pkwy
Zionsville, IN 46077-7622
Phone (317) 732-8980

Other practice location 19

29 Sebago Rd
Raymond, ME 04071-6823
Phone (207) 838-9073

Other practice location 20

215 Commerce Way Ste 100
Portsmouth, NH 03801-3244
Phone (603) 441-1075

Other names 1

  • Advanced Dermatology and Skin Cancer Center LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, NH, ME, IN4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20041228000548 OH Part B Supplier - Clinic/Group Practice 3971561648 Receives reassigned benefits from 32 practitioners
Practice locations: Boardman, OH; Warren, OH; Salem, OH; Milford, OH; Mentor, OH; Macedonia, OH; Independence, OH
O20220329002691 NH Part B Supplier - Clinic/Group Practice 3971561648 Receives reassigned benefits from 25 practitioners
Practice locations: Stratham, NH; Salem, NH; Portsmouth, NH; Manchester, NH; Exeter, NH; Concord, NH; Bedford, NH
O20220711002375 ME Part B Supplier - Clinic/Group Practice 3971561648 Receives reassigned benefits from 14 practitioners
Practice locations: Raymond, ME; York, ME; Scarborough, ME
O20230823002407 IN Part B Supplier - Clinic/Group Practice 3971561648 Receives reassigned benefits from 18 practitioners
Practice locations: Greenwood, IN; Plainfield, IN; Zionsville, IN; Bloomington, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2275622Optima Dermatology1010 W 2ND Street, Bloomington, IN 47403Provider-performed microscopyJan 24, 2027
20D2256215Optima Dermatology Portland71 US-1, Scarborough, ME 04074Provider-performed microscopyMar 21, 2028
30D2261768Optima Dermatology31 Stiles Rd, FL2, Ste 2100, Salem, NH 03079Certificate of waiverMar 16, 2027
30D2276086Optima Dermatology Pathology Laboratory111 New Hampshire Ave, Ste 3, Portsmouth, NH 03801AccreditationDec 3, 2026
30D2309996Optima Dermatology215 Commerce Way, Ste 100, Portsmouth, NH 03801ComplianceMay 14, 2027
36D2213948Optima Dermatology7676 Reynolds Road, Mentor, OH 44060Provider-performed microscopySep 14, 2027
36D2235311Optima Dermatology Macedonia8183 Golden Link Blvd, Macedonia, OH 44067ComplianceDec 5, 2027
36D2277070Optima Dermatology5817 Happy Hollow Road, Milford, OH 45150ComplianceAug 4, 2026

National Provider Directory

National Provider Directory

Locations

1010 W 2nd St
#O
Bloomington, IN 47403
Phone (812) 200-2458

701 E County Line Rd
Ste 208
Greenwood, IN 46143
Phone (317) 781-3604

701 E County Line Rd
Ste 308
Greenwood, IN 46143
Phone (317) 434-4637

2155 E Main St
#200
Plainfield, IN 46168

2155 E Main St
Ste 200
Plainfield, IN 46168

6639 Whitestown Pkwy
Zionsville, IN 46077
Phone (317) 732-8980

71 US Route 1
Ste J
Scarborough, ME 04074
Phone (207) 464-2712

10 Market Place Dr
#3
York, ME 03909
Phone (207) 305-1959

10 Market Place Dr
Ste 3
York, ME 03909
Phone (207) 305-1959

51 Webb Pl
Ste 240
Dover, NH 03820

1 Hampton Rd
Unit A306
Exeter, NH 03833
Phone (603) 942-2171

111 New Hampshire Ave
Ste 3
Portsmouth, NH 03801
Phone (603) 988-0951

215 Commerce Way
Ste 100
Portsmouth, NH 03801
Phone (603) 433-0056

290 Heritage Ave
Portsmouth, NH 03801
Phone (802) 909-2053

6770 Cincinnati Dayton Rd
Ste 112
Liberty Township, OH 45044
Phone (513) 654-0205

8183 Golden Link Blvd
Northfield, OH 44067
Phone (330) 306-9844

1070 E State St
Salem, OH 44460
Phone (330) 332-5501

1070 E State St
Ste C
Salem, OH 44460
Phone (330) 332-4274

2525 E State St
Salem, OH 44460
Phone (330) 271-8614

614 Wooster Pike
Terrace Park, OH 45174
Phone (513) 831-1331

2223 Niles Cortland Rd SE
Warren, OH 44484
Phone (330) 965-8760

2223 Niles Cortland Rd SE
Ste B
Warren, OH 44484

321 Niles Cortland Rd NE
#R
Warren, OH 44484
Phone (330) 965-8760

321 Niles Cortland Rd NE
Ste B
Warren, OH 44484

1039 Boardman Canfield Rd
Ste B
Youngstown, OH 44512
Phone (330) 965-8760

Practitioners & affiliated clinicians

Practitioners 106

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.

View all 106

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1831187764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NEW HAMPSHIRE AVE STE 2",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038012864",
            "telephone_number": "802-909-2053",
            "fax_number": "330-965-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 BOARDMAN CANFIELD RD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124222",
            "telephone_number": "330-965-8760",
            "fax_number": "330-965-9325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Hampton Rd Unit A306",
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            "state": "NH",
            "postal_code": "038334848",
            "country_code": "US",
            "telephone_number": "603-942-2171",
            "fax_number": "603-371-3104",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "71 US Route 1 Ste J",
            "address_purpose": "LOCATION",
            "city": "Scarborough",
            "state": "ME",
            "postal_code": "040747168",
            "country_code": "US",
            "telephone_number": "207-464-2712",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "31 Stiles Rd Ste 2100",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "NH",
            "postal_code": "030793035",
            "country_code": "US",
            "telephone_number": "603-942-2020",
            "fax_number": "603-288-1722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5817 Happy Hollow Rd",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "OH",
            "postal_code": "451501848",
            "country_code": "US",
            "telephone_number": "513-327-9244",
            "fax_number": "513-323-5201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2223 Niles Cortland Rd SE",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "OH",
            "postal_code": "444843043",
            "country_code": "US",
            "telephone_number": "330-965-8760",
            "fax_number": "330-469-9706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8183 Golden Link Blvd",
            "address_purpose": "LOCATION",
            "city": "Macedonia",
            "state": "OH",
            "postal_code": "44067",
            "country_code": "US",
            "telephone_number": "330-778-1278",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "321 Niles Cortland Rd NE # Uniteb",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "OH",
            "postal_code": "444841974",
            "country_code": "US",
            "telephone_number": "330-800-5963",
            "fax_number": "330-469-9706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2525 E State St",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OH",
            "postal_code": "444609303",
            "country_code": "US",
            "telephone_number": "330-271-8614",
            "fax_number": "330-525-9008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 New Hampshire Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "NH",
            "postal_code": "038012864",
            "country_code": "US",
            "telephone_number": "603-988-0951",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7676 Reynolds Rd",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440605110",
            "country_code": "US",
            "telephone_number": "440-283-3015",
            "fax_number": "440-283-3010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1039 Boardman Canfield Rd",
            "address_purpose": "LOCATION",
            "city": "Boardman",
            "state": "OH",
            "postal_code": "445124228",
            "country_code": "US",
            "telephone_number": "330-271-8589",
            "fax_number": "330-965-9325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1027 Boardman Canfield Rd",
            "address_purpose": "LOCATION",
            "city": "Boardman",
            "state": "OH",
            "postal_code": "445124227",
            "country_code": "US",
            "telephone_number": "330-965-8760",
            "fax_number": "330-965-9325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "911 E Aurora Rd",
            "address_purpose": "LOCATION",
            "city": "Macedonia",
            "state": "OH",
            "postal_code": "440561905",
            "country_code": "US",
            "telephone_number": "330-306-9844",
            "fax_number": "330-525-9009",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Southfield Dr Ste 1240",
            "address_purpose": "LOCATION",
            "city": "Plainfield",
            "state": "IN",
            "postal_code": "461684499",
            "country_code": "US",
            "telephone_number": "317-838-9911",
            "fax_number": "317-837-6080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "824 Edwards Dr",
            "address_purpose": "LOCATION",
            "city": "Plainfield",
            "state": "IN",
            "postal_code": "461682791",
            "country_code": "US",
            "telephone_number": "317-406-3254",
            "fax_number": "317-406-3259",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1010 W 2nd St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474032217",
            "country_code": "US",
            "telephone_number": "812-200-2458",
            "fax_number": "930-200-8590",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2800 S State Road 135 Ste 250",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "IN",
            "postal_code": "461436223",
            "country_code": "US",
            "telephone_number": "317-300-1788",
            "fax_number": "317-743-8103",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6639 Whitestown Pkwy",
            "address_purpose": "LOCATION",
            "city": "Zionsville",
            "state": "IN",
            "postal_code": "460777622",
            "country_code": "US",
            "telephone_number": "317-732-8980",
            "fax_number": "317-732-8979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "29 Sebago Rd",
            "address_purpose": "LOCATION",
            "city": "Raymond",
            "state": "ME",
            "postal_code": "040716823",
            "country_code": "US",
            "telephone_number": "207-838-9073",
            "fax_number": "207-203-4875",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 Commerce Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "NH",
            "postal_code": "038013244",
            "country_code": "US",
            "telephone_number": "603-441-1075",
            "fax_number": "603-294-1090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTIMA DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "BERNAT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "330-965-8760",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Skin Cancer Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Advanced Dermatology and Skin Cancer Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.