SOUTHSIDE DERMATOLOGY PLLC
NPI 1750877072
Dermatology in Tulsa, OK

Active since July 10, 2018
720 W 71ST ST, TULSA, OK 74132(918) 760-0700(918) 628-0700 Get Directions Write a Review

NPPES record last updated: March 28, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 24, 2021, Oct 10, 2018, Jul 10, 2018 (3 updates tracked since 2018).

About Southside Dermatology Pllc NPPES

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

SOUTHSIDE DERMATOLOGY PLLC (NPI 1750877072) is a healthcare organization registered as a dermatology in Tulsa, Oklahoma and active in the NPI registry since July 2018. The organization lists Robert Fischer, President, as its authorized official.

NPPES Registry Identity

NPI1750877072
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSOUTHSIDE DERMATOLOGY PLLC
Location Address720 W 71ST STTulsa, OK 74132-7413
Mailing Address6966 S Utica Ave Ste 225Tulsa, OK 74136-3903 · (918) 760-0700
Fax(918) 628-0700
Organization SubpartNo
Authorized OfficialRobert FischerPresident · (918) 760-0700
Enumeration DateJuly 10, 2018
Last NPPES UpdateMarch 28, 20223 updates tracked since enumeration
NPPES CertifiedMarch 28, 2022
✔ NPI 1750877072 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.
720 W 71ST ST, Tulsa, OK 74132

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

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)

Southside Dermatology Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Southside Dermatology PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Dermatology
NPI 1225266307
720 W 71ST ST
Tulsa, OK 74132
(918) 760-0700
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1386969467
5555 E 71ST ST STE 7250
Tulsa, OK 74136
(918) 492-4999
✔ PECOS✔ Accepts Medicare4.8 mi
Micrographic Dermatologic Surgery (MDS)
NPI 1023378759
5801 E 41ST ST STE 200
Tulsa, OK 74135
(918) 760-0700
✔ PECOS✔ Accepts Medicare5.8 mi
Dermatology
NPI 1285610402
1516 S YORKTOWN PL
Tulsa, OK 74104
(918) 712-8888
✔ PECOS✔ Accepts Medicare5.9 mi
Dermatology
NPI 1487621413
3300 S ASPEN AVE STE A
Broken Arrow, OK 74012
(918) 770-4599
✔ PECOS✔ Accepts Medicare11 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Southside Dermatology PLLC's NPI number?

The NPI number for Southside Dermatology PLLC is 1750877072. It was assigned to this organization in the NPPES registry on July 10, 2018.

Where is Southside Dermatology PLLC located?

Southside Dermatology PLLC is located at 720 W 71st St, Tulsa, OK 74132. The listed phone number is (918) 760-0700.

What is Southside Dermatology PLLC's specialty?

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

Is Southside Dermatology PLLC enrolled in Medicare?

Yes. Southside Dermatology PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southside Dermatology PLLC?

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

What insurance does Southside Dermatology PLLC accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma list Southside Dermatology 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 Southside Dermatology PLLC was last updated on March 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.