Phelan Dermatology & Aesthetics

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PHELAN DERMATOLOGY & AESTHETICS

Practice address

520 E 32ND St
Joplin, MO 64804-3904

Phone

(417) 622-0293

Fax

(833) 275-1784

NPI assigned

Apr 15, 2021

Last updated

Dec 24, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jorge Martinez

Title

Practice Administrator

Phone

(417) 622-0293

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Jeremy Glynn Light, MD

  • MOHS-Micrographic Surgery Physician
  • Branson, MO
  • NPI 1831727718

  Dermatology

  Medicare reassignment Care Compare group NPD
• Nathaniel M Phelan, MD

  • Dermatology Physician
  • Joplin, MO
  • NPI 1225327422
  Medicare reassignment Care Compare group NPD
• Brett Neill, MD

  • MOHS-Micrographic Surgery Physician
  • Springfield, MO
  • NPI 1679006522
  Medicare reassignment

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734998400000",
    "number": "1942881677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648043904",
            "telephone_number": "417-622-0293",
            "fax_number": "833-275-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648043904",
            "telephone_number": "417-622-0293",
            "fax_number": "833-275-1784"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21088 US Business Highway 71",
            "address_2": "#7",
            "address_purpose": "LOCATION",
            "city": "Pineville",
            "state": "MO",
            "postal_code": "64856",
            "country_code": "US",
            "telephone_number": "417-622-0293",
            "fax_number": "833-275-1784",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHELAN DERMATOLOGY & AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-15",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-24",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "417-622-0293"
    },
    "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
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean C Pfeffer, MD
• CHI Pham
• Hao Pham
• Tommy Phan, OTR/L
• Pharm Joplin Acquisition, LLC (The Medicine Shoppe Pharmacy)
• Nathaniel M Phelan, MD
• Shane Allan Philliber, CNP
• Andrea Dana Lee Phillips, LPC
• John Phillips, DO
• Kirsten Anne Phillips

• Dermatology Physician in Joplin, MO
• Providers in Joplin, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2024; 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.