RADIANT DERMATOLOGY ASSOCIATES LLC
NPI 1720790330
Dermatology in Fort Wayne, IN

Active since December 15, 2022CLIA 15D2284343 · Microscopy
722 E TILL RD STE 102, FORT WAYNE, IN 46825(260) 487-4065 Get Directions Write a Review

NPPES record last updated: December 15, 2022. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Radiant Dermatology Associates Llc NPPES

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

RADIANT DERMATOLOGY ASSOCIATES LLC (NPI 1720790330) is a healthcare organization registered as a dermatology in Fort Wayne, Indiana and active in the NPI registry since December 2022. The organization holds a CLIA Microscopy certificate valid through June 20, 2027 and lists Dara Spearman, Owner, as its authorized official.

NPPES Registry Identity

NPI1720790330
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameRADIANT DERMATOLOGY ASSOCIATES LLC
Location Address722 E TILL RD STE 102Fort Wayne, IN 46825-2066
Mailing Address722 E Till Rd Ste 102Fort Wayne, IN 46825-2066 · (260) 487-4065
Organization SubpartNo
Authorized OfficialDara SpearmanOwner · (260) 487-4065
Enumeration DateDecember 15, 2022
NPPES CertifiedDecember 15, 2022
NPI 1720790330 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
722 E TILL RD STE 102, Fort Wayne, IN 46825

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 for Provider-Performed Microscopy Procedures (PPMP) 15D2284343

Radiant Dermatology Associates · Ft Wayne, IN
Active · expires Jun 20, 2027
CLIA Number15D2284343
Laboratory TypePhysician Office
Certificate Effective DateJune 21, 2025
Certificate Expiration DateJune 20, 2027
Laboratory DirectorDara D. Spearman
Laboratory Phone(260) 487-4065
Laboratory LocationRadiant Dermatology Associates722 E Till Rd Suite 102, Ft Wayne, IN 46825
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
722 E TILL RD STE 102
FORT WAYNE, IN 46825

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 Radiant Dermatology Associates LLC's NPI number?

The NPI number for Radiant Dermatology Associates LLC is 1720790330. It was assigned to this organization in the NPPES registry on December 15, 2022.

Where is Radiant Dermatology Associates LLC located?

Radiant Dermatology Associates LLC is located at 722 E Till Rd Ste 102, Fort Wayne, IN 46825. The listed phone number is (260) 487-4065.

What is Radiant Dermatology Associates LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Radiant Dermatology Associates LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 15D2284343) is associated with this NPI, valid through June 20, 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 Radiant Dermatology Associates LLC was last updated on December 15, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.