Mosaic Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MOSAIC DERMATOLOGY PLLC

Practice address

567 32ND Ave E Ste 100
West Fargo, ND 58078-8480

Phone

(701) 941-3100

Fax

(701) 941-3301

NPI assigned

Oct 22, 2024

Last updated

Feb 27, 2025By 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

Joanne Montgomery, MDNPI 1609040427

Title

Owner

Phone

(312) 415-8615

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

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 2

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.

• Joanne Ruth Montgomery, M.D.

  • Dermatology Physician
  • West Fargo, ND
  • NPI 1609040427
  Medicare reassignment NPD Authorized official
• Aleksey Ryan, DNP, APRN, FNP-C

  • Nurse Practitioner
  • West Fargo, ND
  • NPI 1124959721
  NPD

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

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1245051390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 32ND AVE E STE 100",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580788480",
            "telephone_number": "701-941-3100",
            "fax_number": "701-941-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 32ND AVE E STE 100",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580788480",
            "telephone_number": "701-941-3100",
            "fax_number": "701-941-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-22",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-415-8615",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne Ruth Montgomery, M.D.
• Emma Morgan
• Lucas Morken, DPT
• Presley Morstad
• Willo Morten
• MPND,Inc (Medical Pharmacy Sheyenne)
• Kathleen Mudgett
• Farhia Ahmed Muhumed
• Angiline B Mulbah
• Lawuo Mulbah

• Dermatology Physician in West Fargo, ND
• Providers in West Fargo, ND by specialty
• Dermatology Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; 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.