NPIMap

Organization Active NPI

Mountain West Derm - Blackhart PLLC

Doing business as Alaska Center for Dermatology

  • Dermatology Physician
  • Anchorage, AK
National Provider Identifier
1124670088
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MOUNTAIN WEST DERM - BLACKHART PLLC
Doing business as
Alaska Center for Dermatology
Practice address
3841 Piper St Ste T4-020
Anchorage, AK 99508-4673
Phone
(907) 646-8500
NPI assigned
Jul 11, 2019
Last updated
Aug 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Authorized official

Name
Bret S Blackhart, MD
Title
Owner
Phone
(775) 560-8668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

3841 Piper St Ste T4-020
Anchorage, AK 99508-4673

Mailing address

3841 Piper St Ste T4-020
Anchorage, AK 99508-4673
Phone (775) 560-8668

Other practice location 1

188 W Northern Lights Blvd Ste 800
Anchorage, AK 99503-3984
Phone (907) 646-8500

Other names 1

  • Alaska Center for Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191023002754 AK Part B Supplier - Clinic/Group Practice 1153609813 Receives reassigned benefits from 10 practitioners
Practice locations: Anchorage, AK

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
02D1009028Mountain West Derm Blackhart PLLC188 W Northern Lights Blvd, Ste 800, Anchorage, AK 99503ComplianceAug 12, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1124670088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST STE T4-020",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084673",
            "telephone_number": "775-560-8668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST STE T4-020",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084673",
            "telephone_number": "907-646-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "188 W Northern Lights Blvd Ste 800",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995033984",
            "country_code": "US",
            "telephone_number": "907-646-8500",
            "fax_number": "907-646-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNTAIN WEST DERM - BLACKHART PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-11",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "BLACKHART",
        "authorized_official_first_name": "BRET",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-560-8668",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alaska Center for Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alaska Center for Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.