NPIMap

Organization Active NPI

Forefront Dermatology, S.C.

  • Dermatology Physician
  • New Richmond, WI
National Provider Identifier
1124461843
Registry record updated Nov 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOREFRONT DERMATOLOGY, S.C.
Practice address
535 Hospital Rd
C/O New Richmond Specialty Clinic
New Richmond, WI 54017
Phone
(715) 246-4624
Fax
(715) 386-5508
NPI assigned
Apr 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2018

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) 482-0671

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

535 Hospital Rd
C/O New Richmond Specialty Clinic
New Richmond, WI 54017

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9010

Other practice location 1

1656 Dorset Ln Ste 400
New Richmond, WI 54017-2449
Phone (715) 246-4624

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000252 WI Part B Supplier - Clinic/Group Practice 3779471701 Receives reassigned benefits from 83 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Mount Pleasant, WI; Neenah, WI; New London, WI; New Richmond, WI; Oak Creek, WI; Oconomowoc, WI; Oconto Falls, WI; Oshkosh, WI…

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
52D2058154Forefront Dermatology, SC1656 Dorset LN Ste 400, New Richmond, WI 54017Provider-performed microscopyApr 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Forefront Dermatology SC120 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541548800000",
    "number": "1124461843",
    "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": "920-663-9010",
            "fax_number": "920-663-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 HOSPITAL RD",
            "address_2": "C/O NEW RICHMOND SPECIALTY CLINIC",
            "city": "NEW RICHMOND",
            "state": "WI",
            "postal_code": "54017",
            "telephone_number": "715-246-4624",
            "fax_number": "715-386-5508"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1656 Dorset Ln Ste 400",
            "address_purpose": "LOCATION",
            "city": "New Richmond",
            "state": "WI",
            "postal_code": "540172449",
            "country_code": "US",
            "telephone_number": "715-246-4624",
            "fax_number": "715-386-5508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-11",
        "last_updated": "2018-11-07",
        "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_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": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Richmond, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.