Forefront Dermatology, S.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

FOREFRONT DERMATOLOGY, S.C.

Doing business as

Atlantic Shore Dermatology, A Forefront Dermatology Practice

Practice address

7000 Wellness Way Ste 7120
St Simons Island, GA 31522-2286

Phone

(912) 634-4966

Fax

(912) 634-6542

NPI assigned

Sep 29, 2020

Last updated

Nov 19, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Betsy J Wernli, MDNPI 1437378973

Title

President

Phone

(920) 482-0671

Specialties & licenses 4

Addresses

Other names 1

• Atlantic Shore Dermatology, A Forefront Dermatology Practice Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

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

• Forefront Dermatology SC

  dba dba Atlantic Shore Dermatology, A Forefront Dermatology Practice

  • Dermatology Physician
  • Brunswick, GA
  • NPI 1962241737

  O20190611003824

  Same enrollment
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Suwanee, GA
  • NPI 1326985185

  O20190611003824

  Same enrollment
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Cumming, GA
  • NPI 1538954649

  O20190611003824

  Same enrollment
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1710449079

  O20190611003824

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

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.

• Betsy Jane Wernli, M.D

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1437378973
  Authorized official Same address or phone
• Jordan Brooks, MD

  • Dermatology Physician
  • Brunswick, GA
  • NPI 1902225030
  NPD
• Ashley C Cavalier, MD

  • Dermatology Physician
  • St Simons Island, GA
  • NPI 1558366534
  NPD
• Rachel Lauren Duncan, PA-C

  • Medical Physician Assistant
  • St Simons Island, GA
  • NPI 1780609917
  NPD
• Victoria Michelle Madray, MD

  • Dermatology Physician
  • St Simons Island, GA
  • NPI 1649847070
  NPD

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1154938579",
    "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": "7000 WELLNESS WAY STE 7120",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315222286",
            "telephone_number": "912-634-4966",
            "fax_number": "912-634-6542"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Lister St",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315015226",
            "country_code": "US",
            "telephone_number": "912-283-4850",
            "fax_number": "912-283-4864",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2804 Saint Marys Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Marys",
            "state": "GA",
            "postal_code": "315584559",
            "country_code": "US",
            "telephone_number": "912-439-3186",
            "fax_number": "912-634-6542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-29",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "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": "193200000X MULTI-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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Shore Dermatology, A Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atlantic Shore Dermatology, A Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in St Simons Island, GA
• Providers in St Simons Island, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.