Active NPI
Affiliated Dermatologists
- Dermatology Physician
- Germantown, WI
National Provider Identifier
1902205206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- 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
- Organization subpart
- No
NPPES NPI Registry
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.
- Title
- Partner/Affiliated Dermatologists
- Phone
- (262) 754-4488
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 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
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407849011 | Other | WI | BILLING NPI NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
-
- MOHS-Micrographic Surgery Physician
- Oak Creek, WI
- NPI 1316656721
O20050414000817
National Provider Directory
National Provider Directory- Tax ID family
- Affiliated Dermatologists SC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dermatology Physician
- New Berlin, WI
- NPI 1194711853
-
- MOHS-Micrographic Surgery Physician
- Oak Creek, WI
- NPI 1316656721
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
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": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BILLING NPI NUMBER",
"identifier": "1407849011",
"state": "WI"
}
],
"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.