NPIMap

Organization Active NPI

Montrose Dermatology PLLC

  • Dermatology Physician
  • Montrose, CO
National Provider Identifier
1154613016
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
46375 Issued in CO
Legal business name
MONTROSE DERMATOLOGY PLLC
Practice address
2730 Commercial Way
Montrose, CO 81401
Phone
(970) 964-4036
Fax
(970) 964-4038
NPI assigned
May 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Authorized official

Name
Dr. Renata Marisa Raziano, MDNPI 1528105814
Title
Physician/Owner
Phone
(970) 964-8463

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 46375 CO Primary

Addresses

Primary practice location

2730 Commercial Way
Montrose, CO 81401

Mailing address

2730 Commercial Way
Montrose, CO 81401
Phone (970) 964-4036

Other identifiers 1

IdentifierTypeStateIssuer
DS7724OtherRAILROAD WORKERS MEDICARE

Other names 1

  • Montrose Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111212000143 CO Part B Supplier - Clinic/Group Practice 3577738012 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Gunnison, CO; Montrose, CO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1563 Ogden Rd
Montrose, CO 81401
Phone (970) 964-4036

2730 Commercial Way
Montrose, CO 81401
Phone (970) 964-4036

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1154613016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 COMMERCIAL WAY",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "81401",
            "telephone_number": "970-964-4036",
            "fax_number": "970-964-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 COMMERCIAL WAY",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "81401",
            "telephone_number": "970-964-4036",
            "fax_number": "970-964-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTROSE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "RAZIANO",
        "authorized_official_first_name": "RENATA",
        "authorized_official_middle_name": "MARISA",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "970-964-8463",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "46375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD WORKERS MEDICARE",
            "identifier": "DS7724",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montrose Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Montrose Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montrose, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.