Dermatology Associates of Indy LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY ASSOCIATES OF INDY LLC

Practice address

1212 Professional Blvd
Evansville, IN 47714-8002

Phone

(918) 492-6333

NPI assigned

Nov 6, 2014

Organization subpart

No

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

Authorized official

Name

Robert Nevin

Title

MBR

Phone

(918) 492-6333

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Dermatology Associates of Indy LLC

  • Dermatology Physician
  • Greenwood, IN
  • NPI 1770959520

  O20150312002083

  Same enrollment

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.

• Vanessa M Mischler, NP

  • Nurse Practitioner
  • Evansville, IN
  • NPI 1104508993

  Dermatology

  Medicare reassignment Care Compare group NPD
• Cole David Lundquist, MD

  • Dermatology Physician
  • Park Ridge, IL
  • NPI 1982688891

  IN

  Medicare reassignment Care Compare group NPD
• Alexandria Anderson, MSN, FNP-C

  • Family Nurse Practitioner
  • Evansville, IN
  • NPI 1881530582
  Medicare reassignment NPD

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1962808774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 PROFESSIONAL BLVD STE B",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148002",
            "telephone_number": "812-401-9030",
            "fax_number": "812-401-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 PROFESSIONAL BLVD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148002",
            "telephone_number": "918-492-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF INDY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "NEVIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "918-492-6333"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariellen Dentino, M.D.
• Jason R Denton, D.P.M.
• Katherine Marie Denton, M.A CCC-SLP
• John W. Deppe, M.D.
• Brooke L Deputy, PTA
• Dermplus
• Michael E Deroche, M.D.
• Jason Robert Derrington
• Brandi L Desper, NP
• Stephenie D Dest, OT

• Dermatology Physician in Evansville, IN
• Providers in Evansville, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.