Advanced Dermatology of Southeast Missouri PC
NPI 1770713950ActiveOrganization· Dermatology· Cape Girardeau, MO
Dermatology in Cape Girardeau, Missouri, registered in NPPES in July 2009. The authorized official on file is Charles Morris Moon, MD, President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1770713950 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 22, 2009 |
| Last updated in NPPES | Sep 15, 2021 |
| Certified by provider | Sep 10, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | 2007038037 | MO |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MO) |
|---|
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