NPIMap

Organization Active NPI

Affiliated Dermatologists

  • Dermatology Physician
  • Germantown, WI
National Provider Identifier
1902205206
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
AFFILIATED DERMATOLOGISTS
Practice address
N96W17035 Division Rd
Suite a
Germantown, WI 53022-6419
Phone
(262) 754-4488
Fax
(262) 754-4940
NPI assigned
Aug 22, 2014
Last updated
May 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Authorized official

Name
Dr. James P Russell, M.D.NPI 1235122870
Title
Partner/Affiliated Dermatologists
Phone
(262) 754-4488

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
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X WI Primary

Addresses

Primary practice location

N96W17035 Division Rd
Suite a
Germantown, WI 53022-6419

Mailing address

13800 W North Ave
Suite 100
Brookfield, WI 53005-4977
Phone (262) 754-4488

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050414000817 WI Part B Supplier - Clinic/Group Practice 8123065794 Receives reassigned benefits from 16 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brookfield, WI; Germantown, WI; Oak Creek, WI

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Affil Dermatologist SC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

N96W17035 Division Rd
Ste A
Germantown, WI 53022
Phone (262) 754-4488

Practitioners & affiliated clinicians

Practitioners 9

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": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1902205206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 W NORTH AVE",
            "address_2": "SUITE 100",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054977",
            "telephone_number": "262-754-4488",
            "fax_number": "262-754-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N96W17035 DIVISION RD",
            "address_2": "SUITE A",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226419",
            "telephone_number": "262-754-4488",
            "fax_number": "262-754-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFILIATED DERMATOLOGISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PARTNER/AFFILIATED DERMATOLOGISTS",
        "authorized_official_telephone_number": "262-754-4488",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.