Mod Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

28493 Issued in NE

Legal business name

MOD DERMATOLOGY PC

Practice address

16910 Frances St
Omaha, NE 68130-2398

Phone

(402) 505-8777

Fax

(402) 933-7767

NPI assigned

Feb 21, 2018

Organization subpart

No

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

Authorized official

Name

Alaina Patera, MBA

Title

Practice Manager

Phone

(402) 505-8777

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NE

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 8

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

• Tina Renee Kinsley, MD

  • Dermatology Physician
  • Omaha, NE
  • NPI 1598883035
  Medicare reassignment Care Compare group NPD
• Melanie A Ortleb, M.D.

  • Dermatology Physician
  • Omaha, NE
  • NPI 1154611622
  Medicare reassignment Care Compare group NPD
• Gage Patrick Rensch, MD

  • Dermatology Physician
  • Omaha, NE
  • NPI 1942706650
  Medicare reassignment Care Compare group NPD
• Victoria Vanroy

  • Dermatology Physician
  • Omaha, NE
  • NPI 1336125517
  Medicare reassignment Care Compare group NPD
• Amanda Hotovy

  • Physician Assistant
  • Omaha, NE
  • NPI 1275027823
  Medicare reassignment Care Compare group
• Mary Otteman, PA

  • Physician Assistant
  • Omaha, NE
  • NPI 1821541905
  Medicare reassignment Care Compare group
• Amy K Price, PA-C

  • Physician Assistant
  • Omaha, NE
  • NPI 1245537067
  Medicare reassignment Care Compare group
• Jennifer J Lansman, PA-C

  • Physician Assistant
  • Omaha, NE
  • NPI 1659027993
  Medicare reassignment

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1982105425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16910 FRANCES ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302398",
            "telephone_number": "402-505-8777",
            "fax_number": "402-933-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16910 FRANCES ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302398",
            "telephone_number": "402-505-8777",
            "fax_number": "402-933-7767"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1106 E 18th St",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "NE",
            "postal_code": "680253224",
            "country_code": "US",
            "telephone_number": "402-505-8777",
            "fax_number": "402-933-7767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOD DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A",
        "authorized_official_last_name": "PATERA",
        "authorized_official_first_name": "ALAINA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "402-505-8777",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NE",
            "license": "28493",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mortleb@moddermatology.ezderm.info",
            "affiliation": "N",
            "endpointDescription": "direct message address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "16910 Frances St",
            "city": "Omaha",
            "state": "NE",
            "country_code": "US",
            "postal_code": "681302398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dermatology Physician in Omaha, NE
• Providers in Omaha, NE by specialty
• Dermatology Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; 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.