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SOUTHEASTERN SKIN CANCER & DERMATOLOGY
NPI 1538433602
Dermatology - MOHS-Micrographic Surgery in Madison, AL

Active since March 06, 2012CLIA 01D2045609 · Certificate of Compliance
104 J E BRISCOE WAY, MADISON, AL 35758(256) 705-3000(256) 705-3105 Get Directions Write a Review

NPPES record last updated: August 21, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Southeastern Skin Cancer & Dermatology NPPES

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

SOUTHEASTERN SKIN CANCER & DERMATOLOGY (NPI 1538433602) is a healthcare organization registered as a mohs-micrographic surgery in Madison, Alabama and active in the NPI registry since March 2012. The organization holds a CLIA Certificate of Compliance certificate valid through January 24, 2027 and lists Albert E Rivera, President, as its authorized official.

NPPES Registry Identity

NPI1538433602
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameSOUTHEASTERN SKIN CANCER & DERMATOLOGY
Location Address104 J E BRISCOE WAYMadison, AL 35758-4822
Mailing Address124 County Road 3401Haleyville, AL 35565-6959
Phone(256) 705-3000
Fax(256) 705-3105
Organization SubpartNo
Authorized OfficialAlbert E RiveraPresident · (859) 351-4994
Enumeration DateMarch 6, 2012
Last NPPES UpdateAugust 21, 2024
NPPES CertifiedAugust 21, 2024
✔ NPI 1538433602 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
License✔ Licensed in AL · DO987
Definition
The 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.
104 J E BRISCOE WAY, Madison, AL 35758
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southeastern Skin Cancer & Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Southeastern Skin Cancer & Dermatology, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Patrick Carr, M.D.
Dermatology
NPI 1790216653
104 J E BRISCOE WAY
Madison, AL 35758
(256) 705-3000
✔ PECOS✔ Accepts MedicareSame address
Vernon Forrester, MD
Dermatology
NPI 1679002729
104 J E BRISCOE WAY
Madison, AL 35758
(256) 705-3000
✔ PECOS✔ Accepts MedicareSame address
Jordan Ivey, MD
Dermatology
NPI 1609368380
104 J E BRISCOE WAY
Madison, AL 35758
(256) 705-3000
✔ PECOS✔ Accepts MedicareSame address
Katelyn Zimmer
Dermatology
NPI 1689028029
8331 MADISON BLVD STE 300
Madison, AL 35758
(256) 705-3000
✔ PECOS✔ Accepts Medicare2.0 mi
Britney Cryer, CRNP
Nurse Practitioner
NPI 1538537030
1205 COUNTY ROAD 1466
Cullman, AL 35058
(256) 739-9711
✔ PECOS✔ Accepts Medicare35 mi
Nitin Tiwari
Dermatology
NPI 1720433592
4439 STATE ROUTE 159 STE G50
Chillicothe, OH 45601
(740) 779-8580
✔ PECOS✔ Accepts Medicare385 mi

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 01D2045609

Southeastern Skin Cancer & Dermatology · Madison, AL
Active · expires Jan 24, 2027
CLIA Number01D2045609
Laboratory TypePhysician Office
Certificate Effective DateJanuary 25, 2025
Certificate Expiration DateJanuary 24, 2027
Laboratory DirectorDr. Albert E. Rivera
Laboratory Phone(256) 705-3000
Laboratory LocationSoutheastern Skin Cancer & Dermatology104J E Briscoe Way, Madison, AL 35758
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Southeastern Skin Cancer & Dermatology's NPI number?

The NPI number for Southeastern Skin Cancer & Dermatology is 1538433602. It was assigned to this organization in the NPPES registry on March 6, 2012.

Where is Southeastern Skin Cancer & Dermatology located?

Southeastern Skin Cancer & Dermatology is located at 104 J E Briscoe Way, Madison, AL 35758. The listed phone number is (256) 705-3000.

What is Southeastern Skin Cancer & Dermatology's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Southeastern Skin Cancer & Dermatology enrolled in Medicare?

Yes. Southeastern Skin Cancer & Dermatology is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southeastern Skin Cancer & Dermatology?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Southeastern Skin Cancer & 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. The largest specialties are Dermatology (5) and Nurse Practitioner (1). Of these, 3 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Southeastern Skin Cancer & Dermatology hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 01D2045609) is associated with this NPI, valid through January 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southeastern Skin Cancer & Dermatology was last updated on August 21, 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.