Organization Active NPI

Center for Surgical Dermatology Inc

  • Dermatology Physician
  • Westerville, OH
National Provider Identifier
1972532091
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CENTER FOR SURGICAL DERMATOLOGY INC
Practice address
428 County Line Road
Westerville, OH 43082-7027
Phone
(614) 847-4100
Fax
(614) 430-1601
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Authorized official

Name
Ronald J Siegle, MD
Title
Owner
Phone
(614) 847-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

428 County Line Road
Westerville, OH 43082-7027

Mailing address

428 County Line Road
Westerville, OH 43082-7027
Phone (614) 847-4100

Other identifiers 1

IdentifierTypeStateIssuer
2438366MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031230000269 OH Part B Supplier - Clinic/Group Practice 9739087602 Receives reassigned benefits from 35 practitioners
Practice locations: Pickerington, OH; Zanesville, OH; Westerville, OH; New Albany, OH; Lancaster, OH; Granville, OH; Gahanna, OH; Columbus, 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
36D0958284Center for Surgical Dermatology &428 County Line Road West, Westerville, OH 43082ComplianceJul 29, 2027

National Provider Directory

National Provider Directory

Locations

170 Northwoods Blvd
Ste 10
Columbus, OH 43235
Phone (614) 436-7188

2000 Newark Granville Rd
Ste 202
Granville, OH 43023
Phone (740) 587-3376

2000 Newark Granville Rd
Ste 203
Granville, OH 43023
Phone (740) 788-8100

1566 Monmouth Dr
Ste 201
Lancaster, OH 43130
Phone (740) 653-2224

428 County Line Rd W
Westerville, OH 43082
Phone (614) 847-4100

428 County Line Rd W
#100
Westerville, OH 43082
Phone (614) 847-4100

428 County Line Rd W
Ste 101
Westerville, OH 43082

817 Forest Ave
Zanesville, OH 43701
Phone (740) 454-7546

Practitioners & affiliated clinicians

Practitioners 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1972532091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 COUNTY LINE ROAD",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827027",
            "telephone_number": "614-847-4100",
            "fax_number": "614-430-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 COUNTY LINE ROAD",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827027",
            "telephone_number": "614-847-4100",
            "fax_number": "614-430-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR SURGICAL DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "SIEGLE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "614-847-4100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2438366",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.