NPIMap

Organization Active NPI

Cary Dermatology Center, P.a.

  • Health Service Clinic/Center
  • Cary, NC
National Provider Identifier
1942201488
Registry record updated Mar 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
CARY DERMATOLOGY CENTER, P.A.
Practice address
101 SW Cary Pkwy
Suite 210
Cary, NC 27511-5562
Phone
(919) 467-8556
NPI assigned
Aug 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2009

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

Authorized official

Name
Dr. Robert B Johnson, M.D.
Title
Owner
Phone
(919) 467-8556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

101 SW Cary Pkwy
Suite 210
Cary, NC 27511-5562

Mailing address

101 SW Cary Pkwy
Suite 210
Cary, NC 27511-5562
Phone (919) 467-8556

Other identifiers 1

IdentifierTypeStateIssuer
0153NOtherNCBLUE CROSS AND BLUE SHIEL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040616000952 NC Part B Supplier - Clinic/Group Practice 7911981956 Receives reassigned benefits from 12 practitioners
Practice locations: Cary, NC

National Provider Directory

National Provider Directory

Locations

101 SW Cary Pkwy
Ste 230
Cary, NC 27511

110 Capcom Ave
Ste 103
Wake Forest, NC 27587
Phone (919) 436-4124

Practitioners & affiliated clinicians

Practitioners 12

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237766400000",
    "number": "1942201488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SW CARY PKWY",
            "address_2": "SUITE 210",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275115562",
            "telephone_number": "919-467-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SW CARY PKWY",
            "address_2": "SUITE 210",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275115562",
            "telephone_number": "919-467-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARY DERMATOLOGY CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2009-03-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-467-8556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "0153N",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; 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.