NPIMap

Organization Active NPI

Community Care Services LLC

Doing business as Renown Dermatology, Laser & Skin Care

  • Dermatology Physician
  • Reno, NV
National Provider Identifier
1174094866
Registry record updated Jun 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
COMMUNITY CARE SERVICES LLC
Doing business as
Renown Dermatology, Laser & Skin Care
Practice address
6536 S McCarran Blvd Ste B
Reno, NV 89509-6152
Phone
(775) 982-8255
Fax
(775) 982-8252
NPI assigned
Dec 6, 2018
Last updated
Jun 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY CARE SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2024

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

Authorized official

Name
Mr. Brett Moore
Title
Cfo Acute Care
Phone
(775) 982-6343

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X

Addresses

Primary practice location

6536 S McCarran Blvd Ste B
Reno, NV 89509-6152

Mailing address

1155 Mill St # M14
Reno, NV 89502-1576
Phone (775) 982-5262

Other names 1

  • Renown Dermatology, Laser & Skin Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060111000900 NV Part B Supplier - Clinic/Group Practice 1951324318 Receives reassigned benefits from 762 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Reno, NV; Carson City, NV; Sparks, NV; Winnemucca, NV; Fallon, NV; Fernley, NV

Other NPIs on the same Medicare enrollment 29

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

View all 29

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
29D2169393Renown Dermatology Laser and Skin Care6536 S McCarran Blvd Ste B, Reno, NV 89509Certificate of waiverJul 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Care Services21 organizations share this tax ID, including this one
Part of
Community Care Services

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717200000000",
    "number": "1174094866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 MILL ST # M14",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021576",
            "telephone_number": "775-982-5262",
            "fax_number": "775-982-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6536 S MCCARRAN BLVD STE B",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895096152",
            "telephone_number": "775-982-8255",
            "fax_number": "775-982-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CARE SERVICES LLC",
        "enumeration_date": "2018-12-06",
        "last_updated": "2024-06-01",
        "certification_date": "2024-06-01",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CFO ACUTE CARE",
        "authorized_official_telephone_number": "775-982-6343",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renown Dermatology, Laser & Skin Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renown Dermatology, Laser & Skin Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2024; 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.