DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA
NPI 1033459011
Dermatology - Clinical & Laboratory Dermatological Immunology in Jacksonville, NC
NPI Status: Active since February 27, 2013
Contact Information
2145 COUNTRY CLUB RD
JACKSONVILLE, NC
ZIP 28546
Phone: (252) 633-4461
Fax: (252) 633-6016
- Organization
- Dermatology
- Clinical & Laboratory Dermatological Imm...
- CLIA Number: 34D2056673
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 03-26-2026
About DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA
This page provides the complete NPI Profile along with additional information for Dermatology Associates Of Coastal Carolina, a provider established in Jacksonville, North Carolina operating as a Dermatology, focusing in clinical & laboratory dermatological immunology . The healthcare provider is registered in the NPI registry with number 1033459011 assigned on February 2013. The practitioner's primary taxonomy code is 207NI0002X. The provider is registered as an organization and their NPI record was last updated 3 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. James Polo M.d. (Md/owner)
- NPI
- 1033459011
- Provider Name
- DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA
- Entity Type
- Organization
- Location Address
- 2145 COUNTRY CLUB RD JACKSONVILLE, NC 28546
- Location Phone
- (252) 633-4461
- Location Fax
- (252) 633-6016
- Mailing Address
- PO BOX 890283 CHARLOTTE, NC 28289
- Mailing Phone
- (252) 633-4461
- Mailing Fax
- (252) 633-6016
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-27-2013
- Last Update Date
- 09-21-2022
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology Clinical & Laboratory Dermatological Immunology
- Taxonomy Code
- 207NI0002X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 34D2056673
- Facility Type
- Practitioner Other
- Certificate Effective Date
- March 27, 2024
- Certificate Expiration Date
- March 26, 2026
- Laboratory Director
- SCOTT D. MCCLELLAN
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Dermatology Associates Of Coastal Carolina after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 3 | 3 | 4 | 5 | 9 | 0 | 1 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 6 | 3 | 8 | 5 | 18 | 0 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 6 + 3 + 8 + 5 + 1 + 8 + 0 + 2 + 24 = 59 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 59 = 1 | 1 | ||||||||
The NPI number 1033459011 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 5 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1609058304 | MS. LISA MARIE BRISSON MPT Individual | Physical Therapist | 2145 COUNTRY CLUB RD JACKSONVILLE, NC 28546 (704) 798-0572 |
| 1174587745 | DR. SEAN P SCULLY MD Individual | Orthopaedic Surgery | 2145 COUNTRY CLUB RD JACKSONVILLE, NC 28546 (910) 939-5759 |
| 1851364335 | MR. DAVID HUSTON ALLGOOD PA-C Individual | Physician Assistant | 2145 COUNTRY CLUB RD JACKSONVILLE, NC 28546 (910) 478-4000 |
| 1710962436 | PATRICE LEANN STANGE OTR/L, OTD, CHT Individual | Occupational Therapist | 2145 COUNTRY CLUB RD JACKSONVILLE, NC 28546 (252) 726-1802 |
| 1821871187 | ALLEN JACOB HOWE PT, DPT Individual | Physical Therapist | 2145 COUNTRY CLUB RD JACKSONVILLE, NC 28546 (252) 726-1802 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1033459011, enumerated in the NPI registry as an "organization" on February 27, 2013
The provider is located at 2145 Country Club Rd Jacksonville, Nc 28546 and the phone number is (252) 633-4461
This medical organization specializes in Dermatology with taxonomy code 207NI0002X with a focus in Clinical & Laboratory Dermatological Immunology
The provider's CLIA number is 34D2056673 for a "practitioner other" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing..
This NPI record was last updated on February 27, 2013. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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