1. Home
  2. Directory
  3. Missouri
  4. Cape Girardeau
  5. Dermatology
  6. NPI Profile

ADVANCED DERMATOLOGY OF SOUTHEAST MISSOURI PC
NPI 1770713950
Dermatology in Cape Girardeau, MO

Active since July 22, 2009CLIA 26D2000800 · Certificate of Compliance
2116 MEGAN DR STE 102, CAPE GIRARDEAU, MO 63701(573) 335-7546(573) 335-7550 Get Directions Write a Review

NPPES record last updated: September 15, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Advanced Dermatology Of Southeast Missouri Pc NPPES

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

ADVANCED DERMATOLOGY OF SOUTHEAST MISSOURI PC (NPI 1770713950) is a healthcare organization registered as a dermatology in Cape Girardeau, Missouri and active in the NPI registry since July 2009. The organization holds a CLIA Certificate of Compliance certificate valid through June 7, 2028 and lists Charles Morris Moon, President, as its authorized official.

NPPES Registry Identity

NPI1770713950
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameADVANCED DERMATOLOGY OF SOUTHEAST MISSOURI PC
Location Address2116 MEGAN DR STE 102Cape Girardeau, MO 63701-1979
Mailing Address1359 N Mount Auburn RdCape Girardeau, MO 63701-1727 · (573) 335-7546 · Fax (573) 335-7550
Phone(573) 335-7546
Fax(573) 335-7550
Organization SubpartNo
Authorized OfficialCharles Morris MoonPresident · (573) 335-7546
Enumeration DateJuly 22, 2009
Last NPPES UpdateSeptember 15, 2021
NPPES CertifiedSeptember 10, 2021
✔ NPI 1770713950 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in MO · 2007038037
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.
2116 MEGAN DR STE 102, Cape Girardeau, MO 63701
Open in Google Maps ↗

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

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter Health 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)

Advanced Dermatology Of Southeast Missouri Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Advanced Dermatology Of Southeast Missouri PC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 6 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Christina Cossou, FNP
Nurse Practitioner
NPI 1013459312
2116 MEGAN DR STE 102
Cape Girardeau, MO 63701
(573) 335-7546
✔ PECOS✔ Accepts MedicareSame address
Richard Limbert, DO
Dermatology
NPI 1518222082
2116 MEGAN DR STE 102
Cape Girardeau, MO 63701
(573) 335-7546
✔ PECOS✔ Accepts MedicareSame address
Brittany Smith, FNP-C
Nurse Practitioner
NPI 1912736430
2116 MEGAN DR STE 102
Cape Girardeau, MO 63701
(573) 335-7546
✔ PECOS✔ Accepts MedicareSame address
Danielle Toal, DNP, APRN, FNP-C
Nurse Practitioner
NPI 1346781069
2116 MEGAN DR SUITE102
Cape Girardeau, MO 63701
(573) 335-7546
✔ PECOS✔ Accepts MedicareSame address
Heather Miller, FNP
Nurse Practitioner
NPI 1396072120
2116 MEGAN DRIVE SUITE 102
Cape Girardeau, MO 63701
(573) 335-7546
✔ PECOS✔ Accepts Medicare0.1 mi
Charles Moon, MD
Dermatology
NPI 1487712295
1359 N MOUNT AUBURN RD
Cape Girardeau, MO 63701
(573) 335-7546
✔ PECOS✔ Accepts Medicare1.2 mi
Jessica Miller, DNP, NP-C
Nurse Practitioner
NPI 1174019798
115 E BUSINESS US HIGHWAY 60
Dexter, MO 63841
(573) 335-7546
✔ PECOS✔ Accepts Medicare42 mi
Theresa Mattingly, M.D.
Dermatology
NPI 1265849053
3265 NE RALPH POWELL RD
Lees Summit, MO 64064
(816) 524-4747
✔ PECOS✔ Accepts Medicare283 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

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 26D2000800

Advanced Dermatology Of Southeast Missouri · Cape Girardeau, MO
Active · expires Jun 7, 2028
CLIA Number26D2000800
Laboratory TypePhysician Office
Certificate Effective DateJune 8, 2026
Certificate Expiration DateJune 7, 2028
Laboratory DirectorCharles M. Moon
Laboratory Phone(573) 335-7546
Laboratory LocationAdvanced Dermatology Of Southeast Missouri2116 Megan Drive Suite 102, Cape Girardeau, MO 63701
CLIA data matches this NPI record on: Address 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 Advanced Dermatology Of Southeast Missouri PC's NPI number?

The NPI number for Advanced Dermatology Of Southeast Missouri PC is 1770713950. It was assigned to this organization in the NPPES registry on July 22, 2009.

Where is Advanced Dermatology Of Southeast Missouri PC located?

Advanced Dermatology Of Southeast Missouri PC is located at 2116 Megan Dr Ste 102, Cape Girardeau, MO 63701. The listed phone number is (573) 335-7546.

What is Advanced Dermatology Of Southeast Missouri PC's specialty?

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

Is Advanced Dermatology Of Southeast Missouri PC enrolled in Medicare?

Yes. Advanced Dermatology Of Southeast Missouri PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Advanced Dermatology Of Southeast Missouri PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Advanced Dermatology Of Southeast Missouri PC. 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 (3). Of these, 4 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Advanced Dermatology Of Southeast Missouri PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 26D2000800) is associated with this NPI, valid through June 7, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Advanced Dermatology Of Southeast Missouri PC 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 5 other insurers list Advanced Dermatology Of Southeast Missouri PC 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 Southeast Missouri PC was last updated on September 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.