ADVANCED DERMATOLOGIC SURGERY (ADVANCED DERMATOLOGIC SURGERY, P.A.) NPI 1003016312

Dermatology (MOHS-Micrographic Surgery) in Overland Park, KS

NPI 1003016312 Organization Dermatology MOHS-Micrographic Surgery CLIA Number 17D0890923 CLIA Certificate of Compliance

About ADVANCED DERMATOLOGIC SURGERY (ADVANCED DERMATOLOGIC SURGERY, P.A.)

Advanced Dermatologic Surgery (advanced Dermatologic Surgery, P.a.) is a provider established in Overland Park, Kansas specializing in dermatology (mohs-micrographic surgery) . The NPI number of Advanced Dermatologic Surgery (advanced Dermatologic Surgery, P.a.) is 1003016312 and was assigned on July 2007. The practitioner's primary taxonomy code is 207ND0101X. The provider is registered as an organization and their NPI record was last updated one year ago. Advanced Dermatologic Surgery (advanced Dermatologic Surgery, P.a.) operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Advanced Dermatologic Surgery. The authorized official of this NPI record is Mr. Greg Albers Mpa (Cfo)

The CLIA number of Advanced Dermatologic Surgery is 17D0890923 registered as a "ambulatory surgery center" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued to Advanced Dermatologic Surgery after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.

NPI

1003016312

Provider NameADVANCED DERMATOLOGIC SURGERY (ADVANCED DERMATOLOGIC SURGERY, P.A.)
Provider Location Address6901 W 121ST ST OVERLAND PARK, KS 66209
Provider Mailing Address6901 W 121ST ST OVERLAND PARK, KS 66209
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameADVANCED DERMATOLOGIC SURGERY
Other Name TypeDoing Business As (3)
Enumeration Date07-24-2007
Last Update Date12-30-2020


Primary Taxonomy

Taxonomy Code207ND0101X
ClassificationDermatology
TypeAllopathic & Osteopathic Physicians
SpecializationMOHS-Micrographic Surgery
Taxonomy DescriptionThe highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Business Address

ADVANCED DERMATOLOGIC SURGERY
6901 W 121ST ST
OVERLAND PARK, KS
ZIP 66209
Phone: (913) 661-1755
Fax: (913) 661-9260

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Mailing Address

ADVANCED DERMATOLOGIC SURGERY
6901 W 121ST ST
OVERLAND PARK, KS
ZIP 66209
Phone: (913) 661-1755
Fax: (913) 661-9260



Authorized Official

Authorized Official NameMR. GREG ALBERS MPA
Authorized Official TitleCFO
Authorized Official Phone(913) 661-1755

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003016312 is:

CLIA Number17D0890923
Facility TypeAMBULATORY SURGERY CENTER
Certificate TypeCertificate of Compliance

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1174400000XOther Service ProvidersSpecialist04-25136KSNo

Taxonomy Description: an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

2291U00000XLaboratoriesClinical Medical Laboratory04-25136KSNo

Taxonomy Description: (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
17D0890923OTHER (01)

Other Providers at the same location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1487659959DR. TIMOTHY L PARKER MD
Individual
Dermatology (MOHS-Micrographic Surgery)6901 W 121ST ST
OVERLAND PARK, KS 66209
(913) 661-1755
1649376757ADS HEALTHCARE LLC
Organization
Clinic/Center (Ambulatory Surgical)6901 W 121ST ST
OVERLAND PARK, KS 66209
(913) 661-1755
1689841025DR. THOMAS LEWIS HAMAGUCHI HOCKER M.D.
Individual
Dermatology (MOHS-Micrographic Surgery)6901 W 121ST ST
OVERLAND PARK, KS 66209
(913) 661-1755

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.