NPIMap

Organization Active NPI

Forefront Dermatology SC

Doing business as Arizona Dermatology Group, a Forefront Dermatology Practice

  • Dermatology Physician
  • Prescott Valley, AZ
National Provider Identifier
1225893548
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOREFRONT DERMATOLOGY SC
Doing business as
Arizona Dermatology Group, a Forefront Dermatology Practice
Practice address
2820 N Glassford Hill Rd Ste 103
Prescott Valley, AZ 86314-2256
Phone
(928) 772-8553
Fax
(928) 776-0405
NPI assigned
Feb 15, 2024
Last updated
Feb 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Plastic Surgery Physician 208200000X NU
Surgery of the Hand (Plastic Surgery) Physician 2082S0105X NU

Addresses

Primary practice location

2820 N Glassford Hill Rd Ste 103
Prescott Valley, AZ 86314-2256

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Other names 1

  • Arizona Dermatology Group, a Forefront Dermatology Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210407000493 AZ Part B Supplier - Clinic/Group Practice 3779471701 Receives reassigned benefits from 29 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ; Sahuarita, AZ; Prescott, AZ; Phoenix, AZ; Oro Valley, AZ; Cottonwood, AZ; Gilbert, AZ; Prescott Valley, AZ

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Dba Advanced Dermatology121 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

2295 E Vistoso Commerce Loop
Oro Valley, AZ 85755
Phone 5202935757 ext. 7143

Practitioners & affiliated clinicians

Practitioners 4

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": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1225893548",
    "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": "2820 N GLASSFORD HILL RD STE 103",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142256",
            "telephone_number": "928-772-8553",
            "fax_number": "928-776-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "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": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Dermatology Group, a Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; 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.