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One provider matched this enrollment ID.

Enrollment ID O20041005000780 resolves to a single NPI record. Open the full profile for complete detail.

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MD
NPI · 1215007455 · Active
Madison Dermatology LLC
Procedural Dermatology Physician · Madison, Indiana
Active
NPI
1215007455
Enrollment ID
O20041005000780
Taxonomy
207NS0135X
Type
Part B Supplier - Clinic/Group Practice

Medicare enrollment

This provider holds a Medicare enrollment on file with the Provider Enrollment, Chain and Ownership System (PECOS). Each enrollment carries a public Medicare Enrollment ID (ENRLMT_ID) used by billers and intermediaries.

Part B Supplier

Source: CMS PECOS public enrollment file.

Secondary identifiers

Additional identifiers this provider has registered with NPPES. Used by medical billers, credentialers, and insurance verifiers to cross-reference claims and enrollments.

Other

  • 15D1048313IN· Issued by CLIA FOR COLUMBUS LOCATIO
  • 15D0952312IN· Issued by CLIA FOR MADISON LOCATION

Source: NPPES public registry.

ReferenceAbout Medicare Enrollment IDs

A Medicare Enrollment ID (ENRLMT_ID) is a 15-character public identifier assigned by the CMS Provider Enrollment, Chain and Ownership System (PECOS) when a provider, supplier, or organisation enrols in Medicare. Each row reflects one enrolment record: a single NPI can hold multiple enrolments across provider types, states, or supplier categories. Data here is mirrored from the quarterly public PECOS enrolment file published on data.cms.gov.