NPIMap

Organization Active NPI

Aesthetic Dermatologic Surgery

  • MOHS-Micrographic Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1982897450
Registry record updated Aug 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
2001005039 Issued in MO
Legal business name
AESTHETIC DERMATOLOGIC SURGERY
Practice address
9717 Landmark Parkway Dr
Suite 115
Saint Louis, MO 63127-1628
Phone
(314) 849-7546
Fax
(314) 849-7558
NPI assigned
Aug 19, 2007
Last updated
Aug 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2009

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

Authorized official

Name
Dr. Erin Scott Gardner, M.D.NPI 1285630061
Title
Physician/Owner
Phone
(314) 849-7546

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 2001005039 MO
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X 2001005039 MO Primary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X 2001005039 MO
Pediatric Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NP0225X 2001005039 MO
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X 2001005039 MO

Addresses

Primary practice location

9717 Landmark Parkway Dr
Suite 115
Saint Louis, MO 63127-1628

Mailing address

PO Box 270686
Saint Louis, MO 63127-0686
Phone (314) 849-7546

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050908000202 MO Part B Supplier - Clinic/Group Practice 5991735078 Receives reassigned benefits from 2 practitioners
Practice locations: Saint Louis, MO; St Louis, MO

National Provider Directory

National Provider Directory

Locations

5000 Cedar Plaza Pkwy
Ste 240
Saint Louis, MO 63128
Phone (314) 200-9905

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1187481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251331200000",
    "number": "1982897450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270686",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631270686",
            "telephone_number": "314-849-7546",
            "fax_number": "314-849-7558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9717 LANDMARK PARKWAY DR",
            "address_2": "SUITE 115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271628",
            "telephone_number": "314-849-7546",
            "fax_number": "314-849-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC DERMATOLOGIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-19",
        "last_updated": "2009-08-27",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "314-849-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2001005039",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MO",
            "license": "2001005039",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "MO",
            "license": "2001005039",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "MO",
            "license": "2001005039",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MO",
            "license": "2001005039",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2009; 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.