NPIMap

Organization Active NPI

Dermatology Specialists of Boulder, PC

  • MOHS-Micrographic Surgery Physician
  • Louisville, CO
National Provider Identifier
1053449306
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
DERMATOLOGY SPECIALISTS OF BOULDER, PC
Practice address
1056 S 88TH St
Louisville, CO 80027-9460
Phone
(303) 442-6647
Fax
(303) 442-2696
NPI assigned
Mar 1, 2007
Last updated
Nov 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

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

Authorized official

Name
Shawn B Allen, MDNPI 1043340805
Title
President
Phone
(303) 442-6647

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 43816 CO
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X Primary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X 43816 CO
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

1056 S 88TH St
Louisville, CO 80027-9460

Mailing address

1056 S 88TH St
Louisville, CO 80027-9460
Phone (303) 442-6647

Other practice location 1

905 W 124th Ave Ste 170
Westminster, CO 80234-1716
Phone (303) 442-6647

Other practice location 2

36 S 18th Ave Ste H
Brighton, CO 80601-2452
Phone (303) 442-6647

Other practice location 3

2880 Folsom St
Suite #200
Boulder, CO 80304-3739
Phone (303) 442-6647

Other practice location 4

776 W Eisenhower Blvd
Loveland, CO 80537-3157
Phone (303) 442-6647

Other practice location 5

11990 Grant St Ste 300
Northglenn, CO 80233-1135
Phone (303) 442-6647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071004000308 CO Part B Supplier - Clinic/Group Practice 3678668761 Receives reassigned benefits from 13 practitioners
Practice locations: Boulder, CO; Brighton, CO; Louisville, CO; Loveland, CO; Northglenn, CO; Westminster, CO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0900069Dermatology Specialists11990 Grant Street, Suite 300, Northglenn, CO 80233ComplianceAug 10, 2027
06D1074798Dermatology Specialists of Boulder2880 Folsom St, Ste 200, Boulder, CO 80304ComplianceMar 20, 2028
06D2113513Dermatology Specialists36 18TH Ave Ste H, Brighton, CO 80601Provider-performed microscopyMay 23, 2028
06D2124191Dermatology Specialists1056 S 88TH St, Louisville, CO 80027ComplianceDec 18, 2027
06D2278312Dermatology Specialists776 W Eisenhower Blvd, Loveland, CO 80537Provider-performed microscopyMar 14, 2027

National Provider Directory

National Provider Directory

Locations

2880 Folsom St
Ste 200
Boulder, CO 80304
Phone (303) 442-6647

4840 Riverbend Rd
Ste 100
Boulder, CO 80301
Phone (303) 415-4045

1056 S 88th St
Ste 200
Louisville, CO 80027

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1053449306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1056 S 88TH ST",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800279460",
            "telephone_number": "303-442-6647",
            "fax_number": "303-442-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1056 S 88TH ST",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800279460",
            "telephone_number": "303-442-6647",
            "fax_number": "303-442-2696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "905 W 124th Ave Ste 170",
            "address_purpose": "LOCATION",
            "city": "Westminster",
            "state": "CO",
            "postal_code": "802341716",
            "country_code": "US",
            "telephone_number": "303-442-6647",
            "fax_number": "303-442-2696",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36 S 18th Ave Ste H",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "CO",
            "postal_code": "806012452",
            "country_code": "US",
            "telephone_number": "303-442-6647",
            "fax_number": "303-442-2696",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2880 Folsom St",
            "address_2": "Suite #200",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803043739",
            "country_code": "US",
            "telephone_number": "303-442-6647",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "776 W Eisenhower Blvd",
            "address_purpose": "LOCATION",
            "city": "Loveland",
            "state": "CO",
            "postal_code": "805373157",
            "country_code": "US",
            "telephone_number": "303-442-6647",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11990 Grant St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Northglenn",
            "state": "CO",
            "postal_code": "802331135",
            "country_code": "US",
            "telephone_number": "303-442-6647",
            "fax_number": "303-442-2696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMATOLOGY SPECIALISTS OF BOULDER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-442-6647",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "43816",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CO",
            "license": "43816",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.