DERMATOLOGY CENTER OF NORTH MS PA
NPI 1053491605
Dermatology in Tupelo, MS
About Dermatology Center Of North Ms Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DERMATOLOGY CENTER OF NORTH MS PA (NPI 1053491605) is a healthcare organization registered as a dermatology in Tupelo, Mississippi and active in the NPI registry since October 2006. The organization holds 2 active CLIA laboratory certificates and lists John D Burk, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dermatology Center Of North Ms Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Dermatology Center Of North Ms PA, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA 2
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Compliance 25D0316884
Dermatology Center Of North Ms PA · Tupelo, MSCertificate of Compliance 25D2221332
Dermatology Center Of North Ms PA · Corinth, MSFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dermatology Center Of North Ms PA's NPI number?
The NPI number for Dermatology Center Of North Ms PA is 1053491605. It was assigned to this organization in the NPPES registry on October 17, 2006.
Where is Dermatology Center Of North Ms PA located?
Dermatology Center Of North Ms PA is located at 516 Pegram Dr, Tupelo, MS 38801. The listed phone number is (662) 844-6272.
What is Dermatology Center Of North Ms PA's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Dermatology Center Of North Ms PA enrolled in Medicare?
Yes. Dermatology Center Of North Ms PA is registered in the Medicare PECOS enrollment system.
When is Dermatology Center Of North Ms PA's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Mississippi, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Dermatology Center Of North Ms PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Dermatology, reassign their Medicare billing to Dermatology Center Of North Ms PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Dermatology Center Of North Ms PA hold CLIA laboratory certificates?
Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
What insurance does Dermatology Center Of North Ms PA accept?
Health plans from Cigna Healthcare list Dermatology Center Of North Ms PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Dermatology Center Of North Ms PA was last updated on March 26, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dermatology Center Of North Ms Pa · NPI 1053491605
Dermatology organization in Tupelo, Mississippi. Organization record, active in the CMS NPPES registry since October 17, 2006.
## Identity
- **NPI:** 1053491605 (Entity type: Organization)
- **Enumerated:** October 17, 2006
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** John Burk, PRESIDENT
## Practice location
- **Address:** 516 PEGRAM DR, Tupelo, MS 38801-6347
- **Phone:** (662) 844-6272 · **Fax:** (662) 844-1603
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, Mississippi, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 4 clinicians (Dermatology) reassign Medicare billing to this organization (form CMS-855R); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 26, 2015
- **Other identifiers:** Medicaid 9015434 (MS); Medicare PIN C02188 (MS)
- **CLIA laboratory certificates:** 2 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1053491605) · Data from the CMS NPPES public registry.