Center for Excellence in Dermatology PLLC
Organization Active NPI Specialist · Hermiston, OR
NPI 1093061806 · NPPES record last updated Jun 19, 2014
Key facts
- NPI
- 1093061806
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- CENTER FOR EXCELLENCE IN DERMATOLOGY PLLC
- Practice address
- 1050 W Elm Ave
Suite #220
Hermiston, OR 97838-2700 - Phone
- (509) 735-1100
- Fax
- (509) 735-1180
- NPI assigned
- Jul 30, 2012
- Organization subpart
- No
Authorized official
- Name
- Robert B Hopp
- Title
- Owner
- Phone
- (509) 735-1100
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 13
-
Robert Blaine Hopp, M.D.
-
Julie Kay Hereford, FNP-C
-
Rebecca Q Eng, ARNP
-
Jennifer Mary Corbin, PA-C
-
Travis R Henderson, PA-C
-
Melissa May Jaeger, ARNP, FNP-C
-
Ryan Paul Duarte, M.A., PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2046774 | Center for Excellence in Dermatology | Compliance | Feb 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120817000135 | OR | Part B Supplier - Clinic/Group Practice | 8527123306 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment Practice locations: Hermiston, OR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
1050 W Elm Ave
Suite #220
Hermiston, OR 97838-2700
Mailing address
8901 W Gage Blvd
Kennewick, WA 99336-7148
Phone (509) 735-1100
Other providers in Hermiston, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.