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EAGLE CREEK DERMATOLOGY
NPI 1053561928
Dermatology - Clinical & Laboratory Dermatological Immunology in Indianapolis, IN

Active since September 26, 2008CLIA 15D0687550 · Microscopy
6820 PARKDALE PL, SUITE 211, INDIANAPOLIS, IN 46254(317) 329-7050(317) 328-6809 Get Directions Write a Review

NPPES record last updated: September 11, 2013. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Eagle Creek Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAGLE CREEK DERMATOLOGY (NPI 1053561928) is a healthcare organization registered as a clinical & laboratory dermatological immunology in Indianapolis, Indiana and active in the NPI registry since September 2008. The organization holds a CLIA Microscopy certificate valid through January 2, 2028 and lists Ingrida Iveta Ozols, Partner, as its authorized official.

NPPES Registry Identity

NPI1053561928
Entity TypeOrganization
Primary Taxonomy207NI0002X
Legal Business NameEAGLE CREEK DERMATOLOGY
Location Address6820 PARKDALE PL, SUITE 211Indianapolis, IN 46254-6600
Mailing Address6820 Parkdale Pl, Suite 211Indianapolis, IN 46254-6600 · (317) 329-7050 · Fax (317) 328-6809
Phone(317) 329-7050
Fax(317) 328-6809
Organization SubpartNo
Authorized OfficialIngrida Iveta OzolsPartner · (317) 329-7050
Enumeration DateSeptember 26, 2008
Last NPPES UpdateSeptember 11, 2013
✔ NPI 1053561928 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · Clinical & Laboratory Dermatological ImmunologyAllopathic & Osteopathic Physicians
Taxonomy Code207NI0002X
Licenses✔ Licensed in IN · 01024873✔ Licensed in IN · 01057248
Definition
A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.
Also ListedDermatologyTaxonomy 207N00000X · License 01027554 (IN)
6820 PARKDALE PL, Indianapolis, IN 46254
Open in Google Maps ↗

Group Practice 1

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Eagle Creek Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Eagle Creek Dermatology, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Ingrida Ozols, MD
Dermatology
NPI 1710068796
6820 PARKDALE PLACE SUITE 211
Indianapolis, IN 46254
(317) 329-7050
✔ PECOS✔ Accepts MedicareSame address
Nikolajs Perdue, M.D.
Dermatology
NPI 1639580152
6820 PARKDALE PL STE 211
Indianapolis, IN 46254
(317) 329-7050
✔ PECOS✔ Accepts MedicareSame address
Wendy Wilson, MD
Dermatology
NPI 1427145986
6820 PARKDALE PLACE SUITE 211
Indianapolis, IN 46254
(317) 329-7050
✔ PECOS✔ Accepts MedicareSame address

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

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 for Provider-Performed Microscopy Procedures (PPMP) 15D0687550

Eagle Creek Dermatology · Indianapolis, IN
Active · expires Jan 2, 2028
CLIA Number15D0687550
Laboratory TypePhysician Office
Certificate Effective DateJanuary 3, 2026
Certificate Expiration DateJanuary 2, 2028
Laboratory DirectorIngrida I. Ozols
Laboratory Phone(317) 329-7050
Laboratory LocationEagle Creek Dermatology6820 Parkdale Pl Ste 211, Indianapolis, IN 46254
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently 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 Eagle Creek Dermatology's NPI number?

The NPI number for Eagle Creek Dermatology is 1053561928. It was assigned to this organization in the NPPES registry on September 26, 2008.

Where is Eagle Creek Dermatology located?

Eagle Creek Dermatology is located at 6820 Parkdale Pl Suite 211, Indianapolis, IN 46254. The listed phone number is (317) 329-7050.

What is Eagle Creek Dermatology's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Clinical & Laboratory Dermatological Immunology, with taxonomy code 207NI0002X.

Is Eagle Creek Dermatology enrolled in Medicare?

Yes. Eagle Creek Dermatology is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Eagle Creek Dermatology?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Dermatology, reassign their Medicare billing to Eagle Creek Dermatology. 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 Eagle Creek Dermatology hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 15D0687550) is associated with this NPI, valid through January 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Eagle Creek Dermatology accept?

Health plans from Anthem Blue Cross and Blue Shield list Eagle Creek Dermatology 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 Eagle Creek Dermatology was last updated on September 11, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.