Summit Dermatology and Aesthetics

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SUMMIT DERMATOLOGY AND AESTHETICS

Practice address

1910 E Barnett Rd Ste 101
Medford, OR 97504-8672

Phone

(541) 200-2022

NPI assigned

Jan 11, 2024

Organization subpart

No

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

Authorized official

Name

John Richardson

Title

Partner

Phone

(503) 858-3642

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Practitioners 1

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

• Mariana Delgado Cooper, PA

  • Physician Assistant
  • Medford, OR
  • NPI 1841349297
  Medicare reassignment

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1952172686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 E BARNETT RD STE 101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-200-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 E BARNETT RD STE 101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-200-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DERMATOLOGY AND AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "503-858-3642"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita De-Haan Sullivan, PH.D
• Sandra Jane Sullivan
• Summer Waters, LLC
• Brett A. Summers, R.PH
• Robin Lynn Nicole Summers
• Summit Family Dental Care PC
• Summit View Therapy LLC
• Archana N Sundar
• Tammy Eileen Surbrook
• Nandita Suresh, MD

• Dermatology Physician in Medford, OR
• Providers in Medford, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.