CMS-1500 Box 24J / 33a • NPI
1073528733
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
207NS0135X (CMS 07)
Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)
Box 32 Service Location & ZIP+4
770 BALGREEN DR, STE 201, MANSFIELD, OH, 44906-4106
✓ 9-Digit EDI 837 ZIP+4 (44906-4106)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1073528733 (ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1073528733 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC |
| Plain-English Specialty | Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) NUCC Code: 207NS0135X (Dermatology, Procedural Dermatology) |
| Certifying / Licensing Body | American Board of Dermatology (ABD) |
| Practice Location Address | 770 BALGREEN DR, STE 201, MANSFIELD, OH, 44906-4106 |
| Practice Telephone / Fax | Tel: (419) 756-1600 | Fax: (419) 775-1196 |
| Administrative Mailing Address | PO BOX 735056, DALLAS, TX, 75373-5056 |
| Enumeration & Last Sync | Enumerated: 2006-07-30 | CMS Record Updated: 2026-08-24 |
| Authorized Official | CHRIST TICORAS (OWNER/PRESIDENT) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (207NS0135X)
What Does Taxonomy Code 207NS0135X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207NS0135X translates to:
"Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC)
Typical CPT / Diagnostic Procedures:- Full-Body Dermoscopy & Skin Cancer Screening
- Shave, Punch & Excisional Skin Biopsy (CPT 11102–11107)
- Cryotherapy Destruction of Actinic Keratoses & Viral Warts (CPT 17000)
- Topical Corticosteroids (Triamcinolone, Clobetasol) & Calcineurin Inhibitors
- Topical & Oral Retinoids (Tretinoin, Adapalene, Isotretinoin)
- Doxycycline, Minocycline & Antifungals (Terbinafine, Ketoconazole)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207N00000X — DermatologyPlain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) | State: N/A | License: Verified | Primary: Secondary |
207NS0135X — Dermatology, Procedural DermatologyPlain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) | State: N/A | License: Verified | Primary: Secondary |
207NS0135X — Dermatology, Procedural DermatologyPlain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) | State: OH | License: 35063717T | Primary: Yes (Primary) |
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