Deluxe Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DELUXE DERMATOLOGY LLC

Practice address

1034 S Brentwood Blvd Ste 1000
Saint Louis, MO 63117-1210

Phone

(314) 781-0794

NPI assigned

Oct 3, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Duane Ardie Dilworth Jr., MDNPI 1730507617

Title

Physician

Phone

(314) 781-0794

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 4

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

• Duane Ardie Dilworth Jr., M.D.

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1730507617
  Medicare reassignment Care Compare group NPD Authorized official
• Erica Amber Westbrooks, PA-C

  • Specialist
  • Des Peres, MO
  • NPI 1467703975
  Medicare reassignment Care Compare group
• Erin Beth Yoffie, PA-C

  • Medical Physician Assistant
  • Saint Louis, MO
  • NPI 1053578294
  Medicare reassignment Care Compare group
• Jacquelyn B Garrett, MD

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1851495907
  Medicare reassignment NPD

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

{
    "created_epoch": "1601683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601683200000",
    "number": "1922605906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD STE 1000",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171210",
            "telephone_number": "314-781-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD STE 1000",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171210",
            "telephone_number": "314-781-0794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11125 Dunn Rd Ste 411",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631366132",
            "country_code": "US",
            "telephone_number": "314-355-7111",
            "fax_number": "314-355-8604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DELUXE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-03",
        "last_updated": "2020-10-03",
        "certification_date": "2020-10-03",
        "status": "A",
        "authorized_official_last_name": "DILWORTH",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "ARDIE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "314-781-0794",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI BOARD OF REGISTRATION FOR THE HEALING ARTS",
            "identifier": "2020010839",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@deluxedermstl.com",
            "affiliation": "N",
            "address_1": "1034 S Brentwood Blvd Ste 1000",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rowena Bayudan Delos Santos, MD
• Genevieve A Delrosario, PA-C
• Nicole M Delsoin Pierre, MD MPH
• Delta Medical Supply, Inc.
• Delux Home Health Care LLC
• Dominic Michael Demarco, MD
• Rebecca Derringer Demargel, PT
• Cindy Crabtree Demendoza, OTR/L
• Bethany Lynn Dement, MD
• Amanda Demeo, M.D.

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2020; 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.