What is Advanced Dermatology of Southeast Missouri PC's NPI number?

Advanced Dermatology of Southeast Missouri PC's National Provider Identifier (NPI) is 1770713950, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.

What type of organization is Advanced Dermatology of Southeast Missouri PC?

Advanced Dermatology of Southeast Missouri PC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).

What is Advanced Dermatology of Southeast Missouri PC's phone number?

The practice phone number listed in the NPPES registry for Advanced Dermatology of Southeast Missouri PC is (573) 335-7546.

Does Advanced Dermatology of Southeast Missouri PC accept Medicare?

Advanced Dermatology of Southeast Missouri PC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.

Who is the authorized official for Advanced Dermatology of Southeast Missouri PC?

The authorized official listed on Advanced Dermatology of Southeast Missouri PC's NPPES record is Charles Moon, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.

Is Advanced Dermatology of Southeast Missouri PC's NPI active?

Yes — Advanced Dermatology of Southeast Missouri PC's NPI (1770713950) is active in the NPPES registry as of the last update on 2021-09-15.

OrganizationActiveAccepts Medicare

Advanced Dermatology of Southeast Missouri PC

NPI 1770713950 · Dermatology Physician · Cape Girardeau, MO

Advanced Dermatology of Southeast Missouri PC is a Dermatology Physician organization in Cape Girardeau, MO (NPI 1770713950).

Provider details

NPI number: 1770713950
Entity type: Organization
Primary specialty: Dermatology PhysicianAllopathic & Osteopathic Physicians
Organization subpart: No
Authorized official: Charles Moon, President(573) 335-7546
License: 2007038037 (MO)

Practice location

2116 Megan Dr Ste 102

Cape Girardeau, MO 63701-1979

Phone: (573) 335-7546

Fax: (573) 335-7550

Street-level locationGet directions

More MO providers

Mailing address

1359 N Mount Auburn Rd

Cape Girardeau, MO 63701-1727

Specialties & taxonomies

Dermatology PhysicianPrimary207N00000XLicense 2007038037 (MO)
Allopathic & Osteopathic Physicians

Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)

Profile Score

Detailed profile(86/100 index)

A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.

Registry tenure38% of score
17 yrs in NPPES registry
Profile completeness38% of score
100% of core fields populated
Practice footprint23% of score
1 documented practice location

Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.

Enumerated: 2009-07-22
Last updated: 2021-09-15
Certified: 2021-09-10

Frequently asked questions

What is Advanced Dermatology of Southeast Missouri PC's NPI number?: Advanced Dermatology of Southeast Missouri PC's National Provider Identifier (NPI) is 1770713950, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
What type of organization is Advanced Dermatology of Southeast Missouri PC?: Advanced Dermatology of Southeast Missouri PC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
Where is Advanced Dermatology of Southeast Missouri PC located?: Advanced Dermatology of Southeast Missouri PC's practice location on file with NPPES is 2116 Megan Dr Ste 102, Cape Girardeau, MO 63701-1979.
What is Advanced Dermatology of Southeast Missouri PC's phone number?: The practice phone number listed in the NPPES registry for Advanced Dermatology of Southeast Missouri PC is (573) 335-7546.
Does Advanced Dermatology of Southeast Missouri PC accept Medicare?: Advanced Dermatology of Southeast Missouri PC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
Who is the authorized official for Advanced Dermatology of Southeast Missouri PC?: The authorized official listed on Advanced Dermatology of Southeast Missouri PC's NPPES record is Charles Moon, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
Is Advanced Dermatology of Southeast Missouri PC's NPI active?: Yes — Advanced Dermatology of Southeast Missouri PC's NPI (1770713950) is active in the NPPES registry as of the last update on 2021-09-15.

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Provider details

Practice location

Mailing address

Specialties & taxonomies

Profile Score

Registry dates

Frequently asked questions

Specialties & taxonomies

Profile Score

Frequently asked questions