OHIODERM HOLDING INC. – Dermatopathology Physician, NPI 1174206791
Dermatopathology Physician
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for OHIODERM HOLDING INC.
2200 Timber Trl
Bellefontaine, OH 433119039
Phone: (937) 595-0100
Type: Location
54 W High St Ste C
London, OH 431401093
Phone: (740) 837-4334
Fax: (740) 422-0777
Type: Location
812 Redskin Trl Ste D
Wapakoneta, OH 458958545
Phone: (419) 549-5607
Type: Location
5775 PERIMETER DR STE 200
DUBLIN, OH 430173224
Phone: (614) 845-0418
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: 2023-11-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| O20231114002588 | O | Clinic/Group Practice | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 43311)
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