NPIMap

Organization Active NPI

Cranberry Square Dermatology PC

  • Specialist
  • South Dennis, MA
National Provider Identifier
1982829495
Registry record updated Aug 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
80792 Issued in MA
Legal business name
CRANBERRY SQUARE DERMATOLOGY PC
Practice address
434 Route 134
Suite 1a
South Dennis, MA 02660-3433
Phone
(508) 394-5556
Fax
(508) 394-2735
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2014

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

Authorized official

Name
Dr. Amy Beth Koff, M.D.NPI 1144217670
Title
Owner
Phone
(508) 394-5556

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 80792 MA Primary

Addresses

Primary practice location

434 Route 134
Suite 1a
South Dennis, MA 02660-3433

Mailing address

434 Route 134
Suite 1a
South Dennis, MA 02660-3433
Phone (508) 394-5556

Other identifiers 1

IdentifierTypeStateIssuer
0000M16787OtherMABLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050617000257 MA Part B Supplier - Clinic/Group Practice 1153365366 Receives reassigned benefits from 1 practitioner
Practice locations: South Dennis, MA

National Provider Directory

National Provider Directory

Locations

434 Route 134
Ste A1
South Dennis, MA 02660
Phone (508) 394-5556

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBIFCA

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409184000000",
    "number": "1982829495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 ROUTE 134",
            "address_2": "SUITE 1A",
            "city": "SOUTH DENNIS",
            "state": "MA",
            "postal_code": "026603433",
            "telephone_number": "508-394-5556",
            "fax_number": "508-394-2735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 ROUTE 134",
            "address_2": "SUITE 1A",
            "city": "SOUTH DENNIS",
            "state": "MA",
            "postal_code": "026603433",
            "telephone_number": "508-394-5556",
            "fax_number": "508-394-2735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRANBERRY SQUARE DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2014-08-28",
        "status": "A",
        "authorized_official_last_name": "KOFF",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-394-5556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MA",
            "license": "80792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0000M16787",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Dennis, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; 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.