Dermatopathology Laboratory of Central States

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

DERMATOPATHOLOGY LABORATORY OF CENTRAL STATES

Practice address

7835 Paragon Rd
Dayton, OH 45459

Phone

(937) 434-2351

Fax

(937) 434-1381

NPI assigned

Aug 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Thomas G. Olsen, M.D.

Title

Laboratory Director

Phone

(937) 434-2351

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH, MI2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Dermatopathology of Cen2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Dermatopathology Laboratory of Central States - Michigan

  • Clinical Medical Laboratory
  • Troy, MI
  • NPI 1538552500
  NPD tax ID

Locations

Practitioners 6

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

• Jessica Vicent Hoy, DO

  • Dermatology Physician
  • Lancaster, OH
  • NPI 1528405586
  Medicare reassignment NPD
• Adrienne C Jordan, M.D

  • Anatomic Pathology & Clinical Pathology Physician
  • Dayton, OH
  • NPI 1982845921
  NPD (past)
• Smita Krishnamurthy, MD

  • Dermatopathology (Pathology) Physician
  • Dayton, OH
  • NPI 1568495711
  NPD (past)
• John C. Moad, M.D.

  • Dermatopathology Physician
  • Dayton, OH
  • NPI 1962484204
  NPD (past)
• Colleen Sheridan, MD

  • Dermatopathology (Pathology) Physician
  • Cincinnati, OH
  • NPI 1902882624
  NPD (past)
• Sean Rayl Stephenson, DO

  • General Practice Physician
  • Fenton, MI
  • NPI 1942219621

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535587200000",
    "number": "1912914144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7835 PARAGON RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454594021",
            "telephone_number": "937-434-2351",
            "fax_number": "937-434-1381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7835 PARAGON RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45459",
            "telephone_number": "937-434-2351",
            "fax_number": "937-434-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOPATHOLOGY LABORATORY OF CENTRAL STATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2018-08-30",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "LABORATORY DIRECTOR",
        "authorized_official_telephone_number": "937-434-2351",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0222614",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Joel Derhodes, M.D.
• Byron K Derksen, LPN
• James A. Derksen, MD
• Dermatologists of Southwestern Ohio, LLC.
• Dermatology Associates of Ohio, LLC
• Kathleen Sarah Derr, PA-C
• Kelyea S Derricks-Linder, CPT
• Shkurte Dervisholli, FNP-C
• Alpa Desai, MD
• Bharat R Desai, R.PH

• Clinical Medical Laboratory in Dayton, OH
• Providers in Dayton, OH by specialty
• Clinical Medical Laboratory in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; 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.