NPIMap

Organization Active NPI

Skin & Mohs Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Lee's Summit, MO
National Provider Identifier
1881875227
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
188-0 Issued in MO
Legal business name
SKIN & MOHS SURGERY CENTER, LLC
Practice address
3265 NE Ralph Powell Rd
Lees Summit, MO 64064-2301
Phone
(816) 524-4747
Fax
(816) 524-4929
NPI assigned
Nov 14, 2007
Last updated
Apr 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
OLIVER STREET DERMATOLOGY HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Authorized official

Name
Glenn Goldstein, M.D.NPI 1164460994
Title
Medical Director
Phone
(913) 451-7546

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 188-0 MO Primary

Addresses

Primary practice location

3265 NE Ralph Powell Rd
Lees Summit, MO 64064-2301

Mailing address

3265 NE Ralph Powell Rd
Lees Summit, MO 64064-2301
Phone (816) 524-4747

Other practice location 1

8380 N Tullis Ave
Kansas City, MO 64158-5113
Phone (913) 451-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060926000572 MO Part B Supplier - Ambulatory Surgical Center 0345141800 Practice locations: Lees Summit, MO
O20180125002329 MO Part B Supplier - Ambulatory Surgical Center 0345141800 Practice locations: Kansas City, MO

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Skin and Mohs Surgery Center LLCCCN 26C0001115
Medicare certification status
ActiveFrom the Provider of Services file

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Skin and Mohs Surgery Center LLCCCN 26C0001182
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1881875227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3265 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642301",
            "telephone_number": "816-524-4747",
            "fax_number": "816-524-9313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3265 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642301",
            "telephone_number": "816-524-4747",
            "fax_number": "816-524-4929"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8380 N Tullis Ave",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641585113",
            "country_code": "US",
            "telephone_number": "913-451-7546",
            "fax_number": "913-663-2411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SKIN & MOHS SURGERY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OLIVER STREET DERMATOLOGY HOLDINGS, LLC",
        "enumeration_date": "2007-11-14",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "913-451-7546",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "188-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lee's Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; 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.