Cranberry Square Dermatology PC

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

Last updated

Aug 28, 2014By the provider in NPPES

Organization subpart

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Interoperability endpoints

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

Practitioners 1

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.

• Amy Beth Koff, M.D.

  • Dermatology Physician
  • South Dennis, MA
  • NPI 1144217670
  Medicare reassignment Authorized official

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": [],
    "endpoints": [],
    "other_names": []
}

• Saska Cicovacki
• Kimberly Michelle Concra, LDN
• Owen Cottle, PT, DPT
• Barbara J Coughlin-Martin, RN,LCMT
• Rachel Crafts
• Caitlin Crowley, FNP
• CVS Pharmacy Inc (CVS Pharmacy # 01021)
• Ansel Adam Davis
• Dennis Foot Care
• Dennis Health Center

• Specialist in South Dennis, MA
• Providers in South Dennis, MA by specialty
• Specialist in Massachusetts

• 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.