SOUTHERN DERMATOLOGY, P.A.
NPI 1568415586
Specialist in Raleigh, NC
About Southern Dermatology, P.a. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHERN DERMATOLOGY, P.A. (NPI 1568415586) is a healthcare organization registered as a specialist in Raleigh, North Carolina and active in the NPI registry since May 2006. The organization holds a CLIA Certificate of Compliance certificate valid through June 1, 2027 and lists Angela Ruth Peterman, Md, 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)
Southern Dermatology, P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
27Medicare enrollment records show 27 clinicians reassign Medicare billing to Southern Dermatology, P.A., which bills Medicare for the services they deliver. Of these, 6 practice at this address and 11 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 3
Nearest to this location (20)
See all 27Source: 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 34D0240587
Southern Dermatology · Raleigh, NCFrequently 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 Southern Dermatology, P.A.'s NPI number?
The NPI number for Southern Dermatology, P.A. is 1568415586. It was assigned to this organization in the NPPES registry on May 19, 2006.
Where is Southern Dermatology, P.A. located?
Southern Dermatology, P.A. is located at 4201 Lake Boone Trl Suite 200, Raleigh, NC 27607. The listed phone number is (919) 782-2152.
What is Southern Dermatology, P.A.'s specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Southern Dermatology, P.A. enrolled in Medicare?
Yes. Southern Dermatology, P.A. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southern Dermatology, P.A.?
According to the CMS Revalidation Reassignment List (October 2026 release), 27 clinicians in 3 Medicare specialties reassign their Medicare billing to Southern Dermatology, P.A.. 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 (21), Micrographic Dermatologic Surgery (MDS) (4) and Nurse Practitioner (2). Of these, 6 practice at this address and 11 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southern Dermatology, P.A. hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 34D0240587) is associated with this NPI, valid through June 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southern Dermatology, P.A. accept?
Health plans from Blue Cross and Blue Shield of NC and Cigna Healthcare list Southern Dermatology, P.A. 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 Southern Dermatology, P.A. was last updated on February 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.
# Southern Dermatology, P.a. · NPI 1568415586
Specialist organization in Raleigh, North Carolina. Organization record, active in the CMS NPPES registry since May 19, 2006.
## Identity
- **NPI:** 1568415586 (Entity type: Organization)
- **Enumerated:** May 19, 2006
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Organization subpart:** No
- **Authorized official:** Angela Peterman, MD
## Practice location
- **Address:** 4201 LAKE BOONE TRL, SUITE 200, Raleigh, NC 27607-7511
- **Phone:** (919) 782-2152 · **Fax:** (919) 782-7929
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 27 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (21), Micrographic Dermatologic Surgery (MDS) (4), Nurse Practitioner (2); 6 practice at this address and 11 within 10 miles; [full list](https://npiprofile.com/npi/1568415586/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 14, 2025
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1568415586) · Data from the CMS NPPES public registry.