Individual provider Active NPI

Carol G Burg, MD

  • Dermatology Physician
  • Independence, OH
National Provider Identifier
1992761068
Registry record updated Nov 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
35045077 Issued in OH
Practice address
6701 Rockside Rd
Suite 330
Independence, OH 44131-2358
Phone
(216) 524-4009
Fax
(216) 524-7933
NPI assigned
Apr 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 35045077 OH Primary

Addresses

Primary practice location

6701 Rockside Rd
Suite 330
Independence, OH 44131-2358

Mailing address

6701 Rockside Rd
Suite 330
Independence, OH 44131-2358
Phone (216) 524-4009

Other identifiers 5

IdentifierTypeStateIssuer
000000192649OtherOHANTHEM
P00131656OtherOHRAILROAD MEDICARE-SAG
0527746MedicaidOH
T45077OtherOHAPEX-SUMMACARE
101091OtherOHKAISER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110414000493 OH Practitioner - Dermatology 1850298340 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Albert Einstein College of Medicine of Yeshiva University, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northcoast Dermatology Associates, Inc.Group PAC ID 0648212167, 5 clinicians

Practice addresses (Care Compare)

4807 Rockside Rd
Suite 100
Independence, OH 44131-2188
Phone (216) 524-4009

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions824
Removal or shaving of skin growth1-10
Skin biopsy217

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northcoast Dermatology Associates, Inc. Dermatology CurrentSince Jun 18, 2001 Accepting new patients
Northcoast Dermatology Associates, Inc. Dermatology CurrentSince Jun 18, 2001 Accepting new patients

Locations

6701 Rockside Rd
Ste 330
Independence, OH 44131
Phone (216) 524-4009

4807 Rockside Rd
Ste 100
Seven Hills, OH 44131
Phone (216) 524-4009

Interoperability endpoints

  • Direct secure messaging: cburg36035@ehrdirect.uhhospitals.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194566400000",
    "number": "1992761068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 ROCKSIDE RD",
            "address_2": "SUITE 330",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312358",
            "telephone_number": "216-524-4009",
            "fax_number": "216-524-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 ROCKSIDE RD",
            "address_2": "SUITE 330",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312358",
            "telephone_number": "216-524-4009",
            "fax_number": "216-524-7933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURG",
        "first_name": "CAROL",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2007-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35045077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000192649",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE-SAG",
            "identifier": "P00131656",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0527746",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APEX-SUMMACARE",
            "identifier": "T45077",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "101091",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, OH

Sources for this page

Verify at the official NPI Registry.