Susan D Purcell MD Dermatology LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

2008007453 Issued in MO

Legal business name

SUSAN D PURCELL MD DERMATOLOGY LLC

Practice address

969 N Mason Rd Ste 170
Saint Louis, MO 63141-6387

Phone

(314) 888-5305

NPI assigned

Oct 16, 2016

Organization subpart

No

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

Authorized official

Name

Susan D Purcell, MDNPI 1831244904

Title

Owner

Phone

(314) 985-8000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Purcell Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Susan Deramo Purcell, M.D.

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1831244904
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1476576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1871044735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "969 N MASON RD STE 170",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416387",
            "telephone_number": "314-985-8000",
            "fax_number": "314-985-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 N MASON RD STE 170",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416387",
            "telephone_number": "314-888-5305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN D PURCELL MD DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-16",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "PURCELL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-985-8000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MO",
            "license": "2008007453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1831244904",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Purcell Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eleatha L Surratt, MD
• Sriyanshi Suryadevara, PA
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• Susan Mary Underhill
• Susan Rosga Counseling LLC

• Medical Specialty Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Medical Specialty Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; 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.