NPIMap

Organization Active NPI

Skin Professionals West, P.C.

  • Dermatology Physician
  • Waconia, MN
National Provider Identifier
1992394944
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SKIN PROFESSIONALS WEST, P.C.
Practice address
582 Cherry Dr
Waconia, MN 55387-4578
Phone
(952) 395-6850
Fax
(952) 395-6870
NPI assigned
Jan 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Kamruz Darabi, MDNPI 1235340894
Title
Owner
Phone
(952) 395-6850

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X

Addresses

Primary practice location

582 Cherry Dr
Waconia, MN 55387-4578

Mailing address

582 Cherry Dr
Waconia, MN 55387-4578
Phone (952) 395-6850

Other names 1

  • Darabi Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210416000061 MN Part B Supplier - Clinic/Group Practice 0941618771 Receives reassigned benefits from 4 practitioners
Practice locations: Chaska, MN; Hutchinson, MN; Shakopee, MN; Waconia, MN

National Provider Directory

National Provider Directory

Locations

582 Cherry Dr
Waconia, MN 55387
Phone (612) 567-1941

Practitioners & affiliated clinicians

Practitioners 6

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": "1610582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1992394944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "582 CHERRY DR",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874578",
            "telephone_number": "952-395-6850",
            "fax_number": "952-395-6870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "582 CHERRY DR",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874578",
            "telephone_number": "952-395-6850",
            "fax_number": "952-395-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN PROFESSIONALS WEST, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-14",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "DARABI",
        "authorized_official_first_name": "KAMRUZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-395-6850",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Darabi Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waconia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.