CMS-1500 Box 24J / 33a • NPI
1831187764
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
207N00000X (CMS 07)
Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)
Box 32 Service Location & ZIP+4
987 BOARDMAN CANFIELD RD, BOARDMAN, OH, 44512-4222
✓ 9-Digit EDI 837 ZIP+4 (44512-4222)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1831187764 (OPTIMA DERMATOLOGY LLC) 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 | 1831187764 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | OPTIMA DERMATOLOGY LLC |
| Plain-English Specialty | Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) NUCC Code: 207N00000X (Dermatology) |
| Certifying / Licensing Body | American Board of Dermatology (ABD) |
| Practice Location Address | 987 BOARDMAN CANFIELD RD, BOARDMAN, OH, 44512-4222 |
| Practice Telephone / Fax | Tel: (330) 965-8760 | Fax: (330) 965-9325 |
| Administrative Mailing Address | 111 NEW HAMPSHIRE AVE STE 2, PORTSMOUTH, NH, 03801-2864 |
| Enumeration & Last Sync | Enumerated: 2005-10-13 | CMS Record Updated: 2026-11-03 |
| Authorized Official | JOHN BERNAT (Authorized Official) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (207N00000X)
What Does Taxonomy Code 207N00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207N00000X translates to:
"Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (OPTIMA DERMATOLOGY LLC)
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 |
|---|---|
174400000X — SpecialistPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: N/A | License: Verified | Primary: Secondary |
207N00000X — DermatologyPlain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) | State: N/A | License: Verified | Primary: Yes (Primary) |
207ND0101X — Dermatology, MOHS-Micrographic SurgeryPlain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) | State: N/A | License: Verified | Primary: Secondary |
207ND0900X — Dermatology, DermatopathologyPlain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) | State: N/A | License: Verified | Primary: Secondary |
207ZP0101X — Pathology, Anatomic PathologyPlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Pathology, Anatomic Pathology | State: N/A | License: Verified | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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