NPIMap

Organization Active NPI

Allied Dermatology and Skin Surgery, LLC

  • Dermatology Physician
  • Fairlawn, OH
National Provider Identifier
1932592698
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ALLIED DERMATOLOGY AND SKIN SURGERY, LLC
Practice address
3624 W Market St Ste 101
Fairlawn, OH 44333-4510
Phone
(330) 665-0555
NPI assigned
Mar 5, 2015
Last updated
Nov 19, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Authorized official

Name
Justin WoodhouseNPI 1225128556
Title
Partner
Phone
(330) 665-0555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X

Addresses

Primary practice location

3624 W Market St Ste 101
Fairlawn, OH 44333-4510

Mailing address

3624 W Market St Ste 101
Fairlawn, OH 44333-4510

Other practice location 1

9485 Mentor Ave Ste 102
Mentor, OH 44060-8722
Phone (440) 266-5500

Other practice location 2

5915 Landerbrook Dr Ste 120
Mayfield Hts, OH 44124-4034
Phone (216) 382-3806

Other practice location 3

1560 Corporate Woods Pkwy
Uniontown, OH 44685-8730
Phone (330) 665-0555

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150420001638 OH Part B Supplier - Clinic/Group Practice 1456679646 Receives reassigned benefits from 13 practitioners
Practice locations: Fairlawn, OH; Mayfield Heights, OH; Mentor, OH; Uniontown, OH

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2092567Allied Dermatology and Skin Surgery, LLC3624 West Market Street, Akron, OH 44333ComplianceAug 18, 2027
36D2092579Allied Dermatology and Skin Surgery, LLC9485 Mentor Avenue, Suite 102, Mentor, OH 44060ComplianceAug 17, 2027
36D2092580Allied Dermatology and Skin Surgery, LLC5915 Landerbrook Drive, Suite 120, Mayfield Heights, OH 44124ComplianceFeb 16, 2028

National Provider Directory

National Provider Directory

Locations

3624 W Market St
Fairlawn, OH 44333
Phone (330) 665-0555

3624 W Market St
Ste 101
Fairlawn, OH 44333
Phone (330) 665-0555

1560 Corporate Woods Pkwy
Ste A
Green, OH 44685

5915 Landerbrook Dr
Ste 120
Mayfield Hts, OH 44124
Phone (216) 382-3806

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1932592698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 W MARKET ST STE 101",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443334510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 W MARKET ST STE 101",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443334510",
            "telephone_number": "330-665-0555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9485 Mentor Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440608722",
            "country_code": "US",
            "telephone_number": "440-266-5500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5915 Landerbrook Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Mayfield Hts",
            "state": "OH",
            "postal_code": "441244034",
            "country_code": "US",
            "telephone_number": "216-382-3806",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1560 Corporate Woods Pkwy",
            "address_purpose": "LOCATION",
            "city": "Uniontown",
            "state": "OH",
            "postal_code": "446858730",
            "country_code": "US",
            "telephone_number": "330-665-0555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALLIED DERMATOLOGY AND SKIN SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-05",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "WOODHOUSE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "330-665-0555"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.