NPIMap

Individual provider Active NPI

Alan Lewis, MD

  • Dermatology Physician
  • Gulfport, MS
National Provider Identifier
1912090143
Registry record updated Feb 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
14710R Issued in LA
Practice address
1245 42ND Ave
Gulfport, MS 39501-2666
Phone
(228) 864-8049
Fax
(228) 864-7655
NPI assigned
Oct 2, 2006
Last updated
Feb 5, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 14710R LA Primary
Dermatology Physician 207N00000X 17858 MS

Addresses

Primary practice location

1245 42ND Ave
Gulfport, MS 39501-2666

Mailing address

1245 42ND Ave
Gulfport, MS 39501-2666
Phone (228) 864-8049

Other identifiers 1

IdentifierTypeStateIssuer
1136697MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060410000222 LA Practitioner - DermatologyPractitioner - Other (Physician) 8921017591 Reassigns benefits to 1 organization
I20111121000207 MS Practitioner - DermatologyPractitioner - Other (Physician) 8921017591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tulane Dermatology AffiliatesGroup PAC ID 7416924212, 2 clinicians

Practice addresses (Care Compare)

1245 42ND Ave
Gulfport, MS 39501-2666
Phone (228) 864-8049

4421 Chastant St
Metairie, LA 70006-2053
Phone (504) 570-6370

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.94 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
53.15

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision335
Removal of skin lesions1606
Removal of skin cancer592
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy398

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14710RLAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alan T. Lewis LLC Dermatology CurrentSince Mar 1, 2012 Accepting new patients
Tulane Dermatology Affiliates Dermatology CurrentSince Oct 2, 2001 Accepting new patients
Dermasurgery Center, LLC Dermatology PastSince Aug 1, 2008 Accepting new patients
Poole Dermatology a Professional Medical Corporation Dermatology Past Accepting new patients
The Administrators of the Tulane Educational Fund Past Accepting new patients
Administrators of the Tulane Educational Fund Past Accepting new patients
Benedetto Dermatology,LLC Past Accepting new patients
Benedetto Dermatology, LLC Past Accepting new patients

Locations

4421 Chastant St
Metairie, LA 70006
Phone (228) 864-8049

1245 42nd Ave
Gulfport, MS 39501
Phone (228) 864-8049

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1912090143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 42ND AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012666",
            "telephone_number": "228-864-8049",
            "fax_number": "228-864-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 42ND AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012666",
            "telephone_number": "228-864-8049",
            "fax_number": "228-864-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "LA",
            "license": "14710R",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MS",
            "license": "17858",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1136697",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.