NPIMap

Individual provider Active NPI

Samuel Blake Ecker, D.O.

  • Dermatology Physician
  • Laramie, WY
National Provider Identifier
1033555230
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
0061328 Issued in CO
Practice address
204 McCollum St Ste 106E
Laramie, WY 82070-5151
Phone
(970) 682-3377
Fax
(970) 682-3340
NPI assigned
May 14, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 6858A WY
Dermatology Physician 207N00000X 0061328 CO Primary

Addresses

Primary practice location

204 McCollum St Ste 106E
Laramie, WY 82070-5151

Mailing address

2710 Westridge CT
Fort Collins, CO 80526-6503
Phone (970) 682-3377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190129002988 CO Practitioner - Dermatology 6305112509 Reassigns benefits to 1 organization
I20211210001184 WY Practitioner - Dermatology 6305112509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sage Dermatology LLCGroup PAC ID 2365840824, 3 clinicians

Practice addresses (Care Compare)

1555 Main St
Unit A6
Windsor, CO 80550-5999
Phone (970) 682-3377

1907 Boise Ave
Loveland, CO 80538-5016
Phone (970) 682-3377

1907 Boise Ave
Suite 3
Loveland, CO 80538-4291

204 McCollum St
Suite 107
Laramie, WY 82070-5151
Phone (970) 682-3377

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.15 of 100Reported as group
Quality
92.3
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision100
Removal of skin lesions1637
Removal of skin cancer274
Skin biopsy422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0061328COMDDermatology Physician
6858AWYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sage Dermatology LLC Dermatology CurrentSince Oct 4, 2021 Accepting new patients

Locations

1907 Boise Ave
Loveland, CO 80538
Phone (970) 669-2770

1907 Boise Ave
Ste 3
Loveland, CO 80538
Phone (970) 378-4676

1555 Main St
Unit A6
Windsor, CO 80550
Phone (970) 682-3377

204 McCollum St
Ste 106E
Laramie, WY 82070
Phone (970) 682-3377

204 McCollum St
Ste 107
Laramie, WY 82070
Phone (307) 742-4327

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1033555230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 WESTRIDGE CT",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805266503",
            "telephone_number": "970-682-3377",
            "fax_number": "970-682-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM ST STE 106E",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705151",
            "telephone_number": "970-682-3377",
            "fax_number": "970-682-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKER",
        "first_name": "SAMUEL",
        "middle_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-14",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WY",
            "license": "6858A",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "0061328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laramie, WY

Sources for this page

Verify at the official NPI Registry.