ASSOCIATES IN DERMATOLOGY, PLLC – Dermatology Physician, NPI 1629083399
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ASSOCIATES IN DERMATOLOGY, PLLC
130 Stonecrest Rd Ste 104
Shelbyville, KY 400658126
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
1005 E Lewis and Clark Pkwy
Clarksville, IN 471292201
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
114 Manor Ave Ste 3
Bardstown, KY 400043231
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
1028 N Dixie Ave Ste 140
Elizabethtown, KY 427012508
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
Associates in Dermatology, PLLC, 3810, Springhurst Boulevard, Freys Hill, Louisville, Jefferson County, Kentucky, 40241, United States
SUITE 200
LOUISVILLE, KY 402416100
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Mailing
908 Wallace Ave Ste 203
Leitchfield, KY 427541495
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
3 Audubon Plaza Dr Ste 630
Louisville, KY 402171362
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
2241 Green Valley Rd
New Albany, IN 471504647
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
325 W Walnut St Ste 300
Lebanon, KY 400331381
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
10302 Brookridge Village Blvd Ste 102
Louisville, KY 402914475
Phone: (502) 583-1749
Fax: (502) 329-8184
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-12-08
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1050 days ago).
Enrollment records
2
Earliest due date
2023-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040325000047 | O | Clinic/Group Practice | KY | 2024-06-30 |
| O20101208001084 | O | Clinic/Group Practice | IN | 2023-07-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 40065)
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