MADISON MEDICAL DERMATOLOGY LLC
NPI 1831506187
Dermatology in Madison, MS

Active since July 18, 2014
1607 DOCTOR'S DRIVE, MADISON, MS 39110(769) 300-2100(601) 944-9780 Get Directions Write a Review

NPPES record last updated: July 18, 2014. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Madison Medical Dermatology Llc NPPES

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

MADISON MEDICAL DERMATOLOGY LLC (NPI 1831506187) is a healthcare organization registered as a dermatology in Madison, Mississippi and active in the NPI registry since July 2014. The organization lists Miriam Shatley, Owner / Md, as its authorized official.

NPPES Registry Identity

NPI1831506187
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMADISON MEDICAL DERMATOLOGY LLC
Location Address1607 DOCTOR'S DRIVEMadison, MS 39110
Mailing Address1607 Doctor's DriveMadison, MS 39110 · (769) 300-2100 · Fax (601) 944-9780
Fax(601) 944-9780
Organization SubpartNo
Authorized OfficialMiriam ShatleyOwner / Md · (769) 300-2100
Enumeration DateJuly 18, 2014
✔ NPI 1831506187 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.
1607 DOCTOR'S DRIVE, Madison, MS 39110

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Madison Medical Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Madison Medical Dermatology LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Dermatology
NPI 1235154121
108 BELLE MEADE POINTE
Flowood, MS 39232
(601) 992-7002
✔ PECOS10.0 mi
Dermatology
NPI 1497767545
108 BELLE MEADE PT
Flowood, MS 39232
(601) 992-7002
✔ PECOS10 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 Madison Medical Dermatology LLC's NPI number?

The NPI number for Madison Medical Dermatology LLC is 1831506187. It was assigned to this organization in the NPPES registry on July 18, 2014.

Where is Madison Medical Dermatology LLC located?

Madison Medical Dermatology LLC is located at 1607 Doctor's Drive, Madison, MS 39110. The listed phone number is (769) 300-2100.

What is Madison Medical Dermatology LLC's specialty?

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

Is Madison Medical Dermatology LLC enrolled in Medicare?

Yes. Madison Medical Dermatology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Madison Medical Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Madison Medical Dermatology 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. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Madison Medical Dermatology LLC was last updated on July 18, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.