ADVANCED DERMATOLOGY OF OHIO, INC
NPI 1760491401
Dermatology in Mason, OH
About Advanced Dermatology Of Ohio, Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ADVANCED DERMATOLOGY OF OHIO, INC (NPI 1760491401) is a healthcare organization registered as a dermatology in Mason, Ohio and active in the NPI registry since August 2006. The organization holds an CLIA Accreditation certificate valid through September 4, 2027, maintains a secondary practice location in Beavercreek, and lists Amy E Declue, Director, Provider Services, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Advanced Dermatology Of Ohio, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
8Medicare enrollment records show 8 clinicians reassign Medicare billing to Advanced Dermatology Of Ohio, Inc, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 4 within 10 miles. They are listed nearest first.
Clinicians, nearest first (8)
Mason, OH 45040
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 Accreditation 36D2136485
Advanced Dermatology Of Ohio · Mason, OHFrequently 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 Advanced Dermatology Of Ohio, Inc's NPI number?
The NPI number for Advanced Dermatology Of Ohio, Inc is 1760491401. It was assigned to this organization in the NPPES registry on August 5, 2006.
Where is Advanced Dermatology Of Ohio, Inc located?
Advanced Dermatology Of Ohio, Inc is located at 4834 Socialville Foster Rd Ste 20, Mason, OH 45040. The listed phone number is (513) 459-1988.
What is Advanced Dermatology Of Ohio, Inc's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Advanced Dermatology Of Ohio, Inc enrolled in Medicare?
Yes. Advanced Dermatology Of Ohio, Inc is registered in the Medicare PECOS enrollment system.
When is Advanced Dermatology Of Ohio, Inc's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Ohio, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Advanced Dermatology Of Ohio, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Advanced Dermatology Of Ohio, Inc. 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 (6) and Nurse Practitioner (2). Of these, 3 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Advanced Dermatology Of Ohio, Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Accreditation (number 36D2136485) is associated with this NPI, valid through September 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Advanced Dermatology Of Ohio, Inc accept?
Health plans from Anthem Blue Cross and Blue Shield and Molina Healthcare list Advanced Dermatology Of Ohio, Inc 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 Advanced Dermatology Of Ohio, Inc was last updated on October 25, 2023. 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.
# Advanced Dermatology Of Ohio, Inc · NPI 1760491401
Dermatology organization in Mason, Ohio. Organization record, active in the CMS NPPES registry since August 5, 2006.
## Identity
- **NPI:** 1760491401 (Entity type: Organization)
- **Enumerated:** August 5, 2006
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Amy Declue, DIRECTOR, PROVIDER SERVICES
## Practice location
- **Address:** 4834 SOCIALVILLE FOSTER RD STE 20, Mason, OH 45040-6827
- **Phone:** (513) 459-1988
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Ohio, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 8 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (6), Nurse Practitioner (2); 3 practice at this address and 4 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 25, 2023
- **Other identifiers:** Medicaid 2531406 (OH)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1760491401) · Data from the CMS NPPES public registry.