NPIMap

Organization Active NPI

Skin Surgery Center, P.S.

Doing business as Skin Surgery Center

  • MOHS-Micrographic Surgery Physician
  • Seattle, WA
National Provider Identifier
1841371960
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
SKIN SURGERY CENTER, P.S.
Doing business as
Skin Surgery Center
Practice address
1229 Madison St
Suite 1480
Seattle, WA 98104-3586
Phone
(206) 346-6647
Fax
(206) 346-6022
NPI assigned
Oct 17, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Peter B Odland, MDNPI 1093896102
Title
President
Phone
(206) 346-6647

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X NU Primary

Addresses

Primary practice location

1229 Madison St
Suite 1480
Seattle, WA 98104-3586

Mailing address

1229 Madison St
Suite 1480
Seattle, WA 98104-3586
Phone (206) 346-6647

Other names 1

  • Skin Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412000084 WA Part B Supplier - Clinic/Group Practice 2567456882 Receives reassigned benefits from 5 practitioners
Practice locations: Bellevue, WA; Kirkland, WA; Seattle, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1841371960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 MADISON ST",
            "address_2": "SUITE 1480",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043586",
            "telephone_number": "206-346-6647",
            "fax_number": "206-346-6022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 MADISON ST",
            "address_2": "SUITE 1480",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043586",
            "telephone_number": "206-346-6647",
            "fax_number": "206-346-6022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN SURGERY CENTER, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ODLAND",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-346-6647",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skin Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.