SOUTHSIDE DERMATOLOGY PLLC
NPI 1073263380
Dermatology in Broken Arrow, OK
About Southside Dermatology Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHSIDE DERMATOLOGY PLLC (NPI 1073263380) is a healthcare organization registered as a dermatology in Broken Arrow, Oklahoma and active in the NPI registry since March 2022. The organization holds a CLIA Certificate of Compliance certificate valid through April 22, 2027 and lists Alison Fischer, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted 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)
Southside Dermatology Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Southside Dermatology PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (5)
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 of Compliance 37D2157238
Southside Dermatology, PLLC · Tulsa, OKFrequently 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 Southside Dermatology PLLC's NPI number?
The NPI number for Southside Dermatology PLLC is 1073263380. It was assigned to this organization in the NPPES registry on March 28, 2022.
Where is Southside Dermatology PLLC located?
Southside Dermatology PLLC is located at 3300 S Aspen Ave Ste A, Broken Arrow, OK 74012. The listed phone number is (918) 760-0700.
What is Southside Dermatology PLLC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Southside Dermatology PLLC enrolled in Medicare?
Yes. Southside Dermatology PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southside Dermatology PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 3 Medicare specialties reassign their Medicare billing to Southside Dermatology PLLC. 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. The largest specialties are Dermatology (3), Micrographic Dermatologic Surgery (MDS) (1) and Nurse Practitioner (1). Of these, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southside Dermatology PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 37D2157238) is associated with this NPI, valid through April 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southside Dermatology PLLC accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma list Southside Dermatology PLLC 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 Southside Dermatology PLLC was last updated on March 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Southside Dermatology Pllc · NPI 1073263380
Dermatology organization in Broken Arrow, Oklahoma. Organization record, active in the CMS NPPES registry since March 28, 2022.
## Identity
- **NPI:** 1073263380 (Entity type: Organization)
- **Enumerated:** March 28, 2022
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Alison Fischer, OWNER
## Practice location
- **Address:** 3300 S ASPEN AVE STE A, Broken Arrow, OK 74012-7501
- **Phone:** (918) 760-0700
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 5 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (3), Micrographic Dermatologic Surgery (MDS) (1), Nurse Practitioner (1); 1 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 28, 2022
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1073263380) · Data from the CMS NPPES public registry.