Active NPI
Forefront Dermatology, S.C.
- Dermatology Physician
- Rogers, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- FOREFRONT DERMATOLOGY, S.C.
- Practice address
- 14165 James Rd Ste 107
Rogers, MN 55374 - Phone
- (763) 515-6200
- Fax
- (763) 575-6202
- NPI assigned
- Aug 12, 2015
- Last updated
- Oct 14, 2021
- 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
- Dr. Betsy J Wernli, MD
- Title
- President
- Phone
- (920) 482-0691
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary | ||
| MOHS-Micrographic Surgery Physician | 207ND0101X | |||
| Procedural Dermatology Physician | 207NS0135X |
Addresses
Primary practice location
14165 James Rd Ste 107
Rogers, MN 55374
Mailing address
801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008
Other practice location 1
21410 136th Ave Ste 105A
Rogers, MN 55374-4921
Phone (763) 515-6200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150901000903 | MN | Part B Supplier - Clinic/Group Practice | 3779471701 |
Receives reassigned benefits from 3 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Minneapolis, MN; Rogers, MN |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba dba Minneapolis Plastic Surgery, A Forefront Practice
- Plastic Surgery Physician
- Minneapolis, MN
- NPI 1528951035
O20150901000903
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 |
|---|---|---|---|
| 24D2100992 | Forefront Dermatology, SC | Compliance | Jun 15, 2028 |
National Provider Directory
National Provider DirectoryLocations
21410 136th Ave
Ste 105A
Rogers, MN 55374
Phone (763) 515-6200
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Dermatology Physician
- Manitowoc, WI
- NPI 1437378973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439337600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1634169600000",
"number": "1114393295",
"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": "14165 JAMES RD STE 107",
"city": "ROGERS",
"state": "MN",
"postal_code": "55374",
"telephone_number": "763-515-6200",
"fax_number": "763-575-6202"
}
],
"practiceLocations": [
{
"address_1": "21410 136th Ave Ste 105A",
"address_purpose": "LOCATION",
"city": "Rogers",
"state": "MN",
"postal_code": "553744921",
"country_code": "US",
"telephone_number": "763-515-6200",
"fax_number": "763-515-6202",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "FOREFRONT DERMATOLOGY, S.C.",
"organizational_subpart": "NO",
"enumeration_date": "2015-08-12",
"last_updated": "2021-10-14",
"certification_date": "2021-10-14",
"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": "920-482-0691",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE 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
},
{
"code": "207NS0135X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Procedural Dermatology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Rogers, MN
- Michelle Cheryl Finnegan-Larson, RN
- First Choice Residential
- First Choice Residential LLC (First Choice Residential)
- Five Star Quality Care - MN, LLC (The WEllstead of Rogers)
- Five Star Rehabilitation and Wellness Services, LLC. (Ageility Physical Therapy Solutions at The Wellstead of Rogers)
- Sydney Fournier-Dingmann
- Janelle France
- Gregory J Frane, M.D.
- Sara Frankwick, MD
- Lyndsey Frogner
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.