Advanced Dermatology & Skin Cancer Center – MOHS-Micrographic Surgery Physician, NPI 1740358159
MOHS-Micrographic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Advanced Dermatology & Skin Cancer Center
1419 VILLAGE DR
SAINT JOSEPH, MO 645062459
Phone: (816) 364-1507
Fax: (816) 364-5711
Type: Mailing
1419, Village Drive, St. Joseph, Buchanan County, Missouri, 64506, United States
SAINT JOSEPH, MO 645062459
Phone: (816) 364-1507
Fax: (816) 364-5711
Type: Location
5701, West 158th Terrace, Sylvan Lake, Overland Park, Johnson County, Kansas, 66223, United States
OVERLAND PARK, KS 662233456
Phone:
Type: Mailing
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: 2019-08-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-11-30 (922 days ago).
Enrollment records
3
Earliest due date
2023-11-30
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 |
|---|---|---|---|---|
| O20070618000215 | O | Clinic/Group Practice | MO | 2024-10-31 |
| O20181106000563 | O | Clinic/Group Practice | KS | 2023-11-30 |
| O20190812002940 | O | Clinic/Group Practice | IA | 2024-08-31 |
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 64506)
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