RIVERSIDE DERMATOLOGY & SPA LLC
NPI 1699262329
Clinic/Center - Multi-Specialty in Hannibal, MO
About Riverside Dermatology & Spa Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RIVERSIDE DERMATOLOGY & SPA LLC (NPI 1699262329) is a healthcare organization registered as a multi-specialty in Hannibal, Missouri and active in the NPI registry since April 2018. The organization holds a CLIA Certificate of Compliance certificate valid through January 12, 2027 and lists Linda Cooke, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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)
Riverside Dermatology & Spa Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Riverside Dermatology & Spa LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians, nearest first (7)
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 26D1096719
Riverside Dermatology · Hannibal, MOFrequently 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 Riverside Dermatology & Spa LLC's NPI number?
The NPI number for Riverside Dermatology & Spa LLC is 1699262329. It was assigned to this organization in the NPPES registry on April 18, 2018.
Where is Riverside Dermatology & Spa LLC located?
Riverside Dermatology & Spa LLC is located at 163 Medical Dr, Hannibal, MO 63401. The listed phone number is (573) 822-4428.
What is Riverside Dermatology & Spa LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.
Is Riverside Dermatology & Spa LLC enrolled in Medicare?
Yes. Riverside Dermatology & Spa LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Riverside Dermatology & Spa LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Riverside Dermatology & Spa 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. The largest specialties are Nurse Practitioner (5) and Dermatology (2). Of these, 1 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Riverside Dermatology & Spa LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 26D1096719) is associated with this NPI, valid through January 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Riverside Dermatology & Spa LLC accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 2 other insurers list Riverside Dermatology & Spa LLC 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 Riverside Dermatology & Spa LLC was last updated on April 18, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Riverside Dermatology & Spa Llc · NPI 1699262329
Multi-Specialty organization in Hannibal, Missouri. Organization record, active in the CMS NPPES registry since April 18, 2018.
## Identity
- **NPI:** 1699262329 (Entity type: Organization)
- **Enumerated:** April 18, 2018
- **Primary specialty:** Clinic/Center - Multi-Specialty · taxonomy 261QM1300X
- **Organization subpart:** No
- **Authorized official:** Linda Cooke, OWNER
## Practice location
- **Address:** 163 MEDICAL DR, Hannibal, MO 63401-6884
- **Phone:** (573) 822-4428
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 7 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (5), Dermatology (2); 1 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 18, 2018
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1699262329) · Data from the CMS NPPES public registry.