NPIMap

Organization Active NPI

Skinpros LLC

  • Dermatology Physician
  • Providence, RI
National Provider Identifier
1881966901
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SKINPROS LLC
Practice address
1287 N Main St
Providence, RI 02904-1856
Phone
(401) 272-2724
Fax
(401) 272-2784
NPI assigned
Feb 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

Authorized official

Name
Dr. Antonio Paulino Cruz, MDNPI 1063603553
Title
Owner/ Manager
Phone
(401) 243-3675

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
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1287 N Main St
Providence, RI 02904-1856

Mailing address

1287 N Main St
Providence, RI 02904-1856
Phone (401) 272-2724

Other identifiers 1

IdentifierTypeStateIssuer
AC81611MedicaidRI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120508000598 RI Part B Supplier - Clinic/Group Practice 8921260951 Receives reassigned benefits from 14 practitioners
Practice locations: Providence, RI

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
41D2041523Skinpros, LLC1287 North Main Street, Providence, RI 02904ComplianceJul 25, 2027

National Provider Directory

National Provider Directory

Locations

175 Nate Whipple Hwy
Ste 207
Cumberland, RI 02864
Phone (401) 658-2180

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1328400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1881966901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1287 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029041856",
            "telephone_number": "401-272-2724",
            "fax_number": "401-272-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1287 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029041856",
            "telephone_number": "401-272-2724",
            "fax_number": "401-272-2784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKINPROS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-05",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "PAULINO",
        "authorized_official_title_or_position": "OWNER/ MANAGER",
        "authorized_official_telephone_number": "401-243-3675",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AC81611",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; 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.