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PADUCAH DERMATOLOGY SURGERY CENTER PLLC
NPI 1689401465
Clinic/Center - Ambulatory Surgical in Paducah, KY

Active since September 17, 2024CLIA Certified · 3 labs
127 ALBEN BARKLEY DRIVE SUITE A, PADUCAH, KY 42001(270) 444-8477(270) 444-8479 Get Directions Write a Review

NPPES record last updated: December 8, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 8, 2025, Nov 24, 2025, May 9, 2025 and 1 more (4 updates tracked since 2024).

About Paducah Dermatology Surgery Center Pllc NPPES

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

PADUCAH DERMATOLOGY SURGERY CENTER PLLC (NPI 1689401465) is a healthcare organization registered as an ambulatory surgical in Paducah, Kentucky and active in the NPI registry since September 2024. The organization holds 3 active CLIA laboratory certificates and lists Erica Housman, Asc Administrator, as its authorized official.

NPPES Registry Identity

NPI1689401465
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NamePADUCAH DERMATOLOGY SURGERY CENTER PLLC
Location Address127 ALBEN BARKLEY DRIVE SUITE APaducah, KY 42001
Mailing Address127 Alben Barkley Dr Ste APaducah, KY 42001-4402 · (270) 444-8477 · Fax (270) 444-8479
Phone(270) 444-8477
Fax(270) 444-8479
Organization SubpartNo
Authorized OfficialErica HousmanAsc Administrator · (270) 444-8477
Enumeration DateSeptember 17, 2024
Last NPPES UpdateDecember 8, 20254 updates tracked since enumeration
NPPES CertifiedDecember 8, 2025
✔ NPI 1689401465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
127 ALBEN BARKLEY DRIVE SUITE A, Paducah, KY 42001
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter of Tennessee and more.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)

Paducah Dermatology Surgery Center Pllc 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 Paducah Dermatology Surgery Center PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Joseph Blackmon, M.D.
Dermatology
NPI 1003133901
3101 PARISA DR
Paducah, KY 42003
(270) 444-8477
✔ PECOS✔ Accepts Medicare0.3 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 3

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 Waiver 18D2315830

Paducah Dermatology Surgery Center, PLLC · Paducah, KY
Active · expires Dec 18, 2026
CLIA Number18D2315830
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateDecember 19, 2024
Certificate Expiration DateDecember 18, 2026
Laboratory DirectorDr. Joseph Blackmon
Laboratory Phone(270) 444-8477
Laboratory LocationPaducah Dermatology Surgery Center, PLLC127 Alben Barkley Dr Suite A, Paducah, KY 42001
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 18D2314165

Paducah Dermatology, PLLC · Paducah, KY
Active · expires Mar 17, 2028
CLIA Number18D2314165
Laboratory TypePhysician Office
Certificate Effective DateMarch 18, 2026
Certificate Expiration DateMarch 17, 2028
Laboratory DirectorDr. Joseph Blackmon
Laboratory Phone(270) 444-8477
Laboratory LocationPaducah Dermatology, PLLC127 Alben Barkley Suite B, Paducah, KY 42001
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.

Certificate of Compliance 18D0875591

Paducah Dermatology · Paducah, KY
Active · expires Nov 26, 2026
CLIA Number18D0875591
Laboratory TypePhysician Office
Certificate Effective DateNovember 27, 2024
Certificate Expiration DateNovember 26, 2026
Laboratory DirectorDr. Joseph Blackmon
Laboratory Phone(270) 444-8477
Laboratory LocationPaducah Dermatology3101 Parisa Drive, Paducah, KY 42003
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 Paducah Dermatology Surgery Center PLLC's NPI number?

The NPI number for Paducah Dermatology Surgery Center PLLC is 1689401465. It was assigned to this organization in the NPPES registry on September 17, 2024.

Where is Paducah Dermatology Surgery Center PLLC located?

Paducah Dermatology Surgery Center PLLC is located at 127 Alben Barkley Drive Suite A, Paducah, KY 42001. The listed phone number is (270) 444-8477.

What is Paducah Dermatology Surgery Center PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Paducah Dermatology Surgery Center PLLC enrolled in Medicare?

Yes. Paducah Dermatology Surgery Center PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Paducah Dermatology Surgery Center PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Paducah Dermatology Surgery Center 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Paducah Dermatology Surgery Center PLLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Paducah Dermatology Surgery Center PLLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter of Tennessee and Anthem Blue Cross and Blue Shield list Paducah Dermatology Surgery Center 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 Paducah Dermatology Surgery Center PLLC was last updated on December 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.