Emporia Dermatology and Skin Cancer Center LLC – Dermatology Physician, NPI 1124094867
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Emporia Dermatology and Skin Cancer Center LLC
747 N Burlington Ave Ste 312
Hastings, NE 689014478
Phone: (402) 462-4872
Fax: (402) 484-6253
Type: Location
820 N Webb Rd Ste 104
Grand Island, NE 688033325
Phone: (308) 384-0133
Fax: (402) 484-6253
Type: Location
1015 Elmhurst Blvd
Salina, KS 674017403
Phone: (785) 376-6400
Fax: (785) 914-5054
Type: Location
210 W 13th St
Ottawa, KS 660673545
Phone: (785) 521-7111
Fax: (620) 208-9335
Type: Location
2509 W 18th Ave
Emporia, KS 668016105
Phone: (620) 341-9335
Fax: (620) 208-9335
Type: Location
2908 W 39th St Ste D
Kearney, NE 688451245
Phone: (370) 270-1100
Type: Location
2735, Pembrook Place, Manhattan, Riley County, Kansas, 66502, United States
MANHATTAN, KS 66502
Phone: (785) 537-4990
Fax: (785) 537-1938
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: 2020-07-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1042 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 |
|---|---|---|---|---|
| O20050608001152 | O | Clinic/Group Practice | KS | 2023-07-31 |
| O20200701001892 | O | Clinic/Group Practice | NE | 2025-10-31 |
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 68901)
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