NPIMap

Organization Active NPI

Vitalskin Medical Group Il PLLC

  • Dermatopathology Physician
  • Saint Louis, MO
National Provider Identifier
1881384915
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
Legal business name
VITALSKIN MEDICAL GROUP IL PLLC
Practice address
621 S New Ballas Rd Ste 5002B
Saint Louis, MO 63141-8270
Phone
(314) 432-3033
Fax
(314) 995-9985
NPI assigned
May 11, 2023
Last updated
May 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Jeremy Scott Youse, MD
Title
Chief Medical Officer
Phone
(217) 729-7650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology Physician 207ND0900X NU Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 5002B
Saint Louis, MO 63141-8270

Mailing address

1111 W Kenyon Rd Ste B
Urbana, IL 61801-1006
Phone (217) 729-7650

National Provider Directory

National Provider Directory
Tax ID family
Vitalskin Medical Group Il PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

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": "1683763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1881384915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W KENYON RD STE B",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618011006",
            "telephone_number": "217-729-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 5002B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418270",
            "telephone_number": "314-432-3033",
            "fax_number": "314-995-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALSKIN MEDICAL GROUP IL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "YOUSE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "217-729-7650",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.