Island Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ISLAND DERMATOLOGY PLLC

Practice address

8435 SE 68TH St
Ste 118
Mercer Island, WA 98040

Phone

(206) 232-7546

Fax

(206) 275-0805

NPI assigned

Jun 30, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Betty J Heupel

Title

Office Manager

Phone

(425) 486-2340

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Kerrie J. Spoonemore, M.D.

  • Dermatology Physician
  • Seattle, WA
  • NPI 1063401305
  NPD (past)

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215966635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8435 SE 68TH ST",
            "address_2": "STE 118",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "98040",
            "telephone_number": "206-232-7546",
            "fax_number": "206-275-0805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8435 SE 68TH ST",
            "address_2": "STE 118",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "98040",
            "telephone_number": "206-232-7546",
            "fax_number": "206-275-0805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEUPEL",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "425-486-2340",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7105935",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Leslie Hughes, MD, PHD
• David Humphrey
• Samruddhi Hurkadli, M.S
• Rachel Shira Hyman, PSYD
• Island Crest Chiropractic Inc
• Island Nutrition and Wellness LLC
• Taro Iwamoto, MS, ATC, CSCS
• Jessica Dorothy Jackson, L.M.P.
• Catherine Ying Jin, MD
• John C Lind DDS

• Dermatology Physician in Mercer Island, WA
• Providers in Mercer Island, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.