Active NPI
Forefront Dermatology, S.C.
- Dermatology Physician
- Norton Shores, MI
National Provider Identifier
1083485510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- FOREFRONT DERMATOLOGY, S.C.
- Practice address
- 6225 Prairie St
Norton Shores, MI 49444-7831 - Phone
- (231) 798-9500
- Fax
- (231) 798-9533
- NPI assigned
- Jan 12, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Betsy J Wernli, MD
- Title
- President
- Phone
- (920) 482-0671
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary | ||
| MOHS-Micrographic Surgery Physician | 207ND0101X |
Addresses
Primary practice location
6225 Prairie St
Norton Shores, MI 49444-7831
Mailing address
801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008
Other practice location 1
650 3 Mile Rd NW Ste 100
Grand Rapids, MI 49544-1624
Phone (616) 784-9300
Other names 1
- Lakeshore Dermatology Laser & Medical Spa, A Forefront Dermatology Pr
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131025001403 | MI | Part B Supplier - Clinic/Group Practice | 3779471701 |
Receives reassigned benefits from 44 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Hancock, MI; Hastings, MI; Jackson, MI; Kalamazoo, MI; Marquette, MI; Norton Shores, MI; Novi, MI; Plymouth, MI… |
Other NPIs on the same Medicare enrollment 14
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Plastic Surgery Physician
- Bingham Farms, MI
- NPI 1134907231
O20131025001403
-
- Dermatology Physician
- Clinton Township, MI
- NPI 1376083436
O20131025001403
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D1014883 | Forefront Dermatology, S C Dba Lakeshore | Compliance | Mar 26, 2028 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Medical Physician Assistant
- Grand Rapids, MI
- NPI 1568864353
-
- Physician Assistant
- Norton Shores, MI
- NPI 1801508593
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705017600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1705017600000",
"number": "1083485510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 YORK ST",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542204630",
"telephone_number": "920-663-9008",
"fax_number": "920-684-1439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6225 PRAIRIE ST",
"city": "NORTON SHORES",
"state": "MI",
"postal_code": "494447831",
"telephone_number": "231-798-9500",
"fax_number": "231-798-9533"
}
],
"practiceLocations": [
{
"address_1": "650 3 Mile Rd NW Ste 100",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495441624",
"country_code": "US",
"telephone_number": "616-784-9300",
"fax_number": "616-784-9308",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "FOREFRONT DERMATOLOGY, S.C.",
"organizational_subpart": "NO",
"enumeration_date": "2024-01-12",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A",
"authorized_official_last_name": "WERNLI",
"authorized_official_first_name": "BETSY",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "920-482-0671",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
},
{
"code": "207ND0101X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Lakeshore Dermatology Laser & Medical Spa, A Forefront Dermatology Pr",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Norton Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.