THE GRAND RESORT DERMATOLOGY
NPI 1366208456
Dermatology in Warren, OH
About The Grand Resort Dermatology NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
THE GRAND RESORT DERMATOLOGY (NPI 1366208456) is a healthcare organization registered as a dermatology in Warren, Ohio and active in the NPI registry since February 2024. The organization lists Robert T Moosally, Medical Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
The Grand Resort Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to The Grand Resort Dermatology, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Avalon Dermatology LLC's NPI number?
The NPI number for Avalon Dermatology LLC is 1366208456. It was assigned to this organization in the NPPES registry on February 26, 2024. The provider is doing business as The Grand Resort Dermatology.
Where is Avalon Dermatology LLC located?
Avalon Dermatology LLC is located at 1 American Way NE, Warren, OH 44484. The listed phone number is (330) 609-8814.
What is Avalon Dermatology LLC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Avalon Dermatology LLC enrolled in Medicare?
Yes. Avalon Dermatology LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Avalon Dermatology LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Avalon Dermatology LLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Avalon Dermatology LLC was last updated on April 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.