Mat-Su Dermatology, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

MAT-SU DERMATOLOGY, LLC

Practice address

2250 S Woodworth Loop Ste 101
Palmer, AK 99645-7457

Phone

(907) 745-7546

Fax

(907) 745-7540

NPI assigned

Jun 24, 2025

Organization subpart

No

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

Authorized official

Name

Melody Mittelsteadt

Title

Coo

Phone

(210) 897-9248

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashley Nicole Smith, PA

  • Physician Assistant
  • Palmer, AK
  • NPI 1548969413

  AK

  Medicare reassignment Care Compare group NPD
• Robert Sorensen, M.D.

  • Dermatology Physician
  • Palmer, AK
  • NPI 1073937835

  AK, Mohs-Micrographic Surgery

  Medicare reassignment Care Compare group NPD
• Hal Bret Willardson, MD

  • Dermatology Physician
  • Palmer, AK
  • NPI 1275924300

  AK

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1750723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755648000000",
    "number": "1063300580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 S WOODWORTH LOOP STE 101",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457457",
            "telephone_number": "907-745-7546",
            "fax_number": "907-745-7540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 S WOODWORTH LOOP STE 101",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457457",
            "telephone_number": "907-745-7546",
            "fax_number": "907-745-7540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAT-SU DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-24",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A",
        "authorized_official_last_name": "MITTELSTEADT",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "210-897-9248"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lina Martin
• Alympi Martusheff, LMT
• Benjamin D Marvin, MD
• Mary Janes House of Healing LLC
• Mat Su Valley Medical Center LLC
• Mat-Su Ear, Nose, Throat & Facial Plastics, Inc.
• Mat-Su Emergency Medicine Physicians Corp
• Mat-Su Plastic Surgery LLC
• Mat-Su Regional Medical Center
• Mat-Su Valley III LLC

• All providers in Palmer, AK
• MOHS-Micrographic Surgery Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; 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.