ADVANCED DERMATOLOGY OF OHIO, INC – Dermatology Physician, NPI 1760491401
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ADVANCED DERMATOLOGY OF OHIO, INC
2361 Lakeview Dr Unit 2361
Beavercreek, OH 454313695
Phone: (937) 306-0200
Type: Location
8940 KINGSRIDGE DR
STE 104
CENTERVILLE, OH 454581632
Phone: (937) 436-1433
Fax: (937) 439-7443
Type: Location
4834 SOCIALVILLE FOSTER RD STE 20
MASON, OH 450406827
Phone: (513) 459-1988
Type: Location
151 Southpoint, 151, Southhall Lane, Maitland, Orange County, Florida, 32810, United States
STE 300
MAITLAND, FL 327517176
Phone: (407) 875-2080
Fax: (407) 650-3455
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: 2004-11-30
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 |
|---|---|---|---|---|
| O20041130000569 | 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 45431)
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