Organization Active NPI

Alpine Dermatology LLC

Doing business as Minden Dermatology

  • Dermatology Physician
  • Minden, NV
National Provider Identifier
1306623749
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ALPINE DERMATOLOGY LLC
Doing business as
Minden Dermatology
Practice address
1661 Lucerne St
Minden, NV 89423-4381
Phone
(775) 782-0700
Fax
(778) 782-0500
NPI assigned
Sep 11, 2023
Last updated
Jul 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Authorized official

Name
Lisa Ann Vandiver
Title
Office Manager
Phone
(775) 782-0700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

1661 Lucerne St
Minden, NV 89423-4381

Mailing address

1661 Lucerne St
Minden, NV 89423-4381
Phone (775) 782-0700

Other names 1

  • Minden Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231129000043 NV Part B Supplier - Clinic/Group Practice 0244688422 Receives reassigned benefits from 4 practitioners
Practice locations: Minden, NV

National Provider Directory

National Provider Directory

Locations

1661 Lucerne St
Minden, NV 89423
Phone (775) 392-3232

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": "1694390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1306623749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 LUCERNE ST",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "894234381",
            "telephone_number": "775-782-0700",
            "fax_number": "778-782-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 LUCERNE ST",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "894234381",
            "telephone_number": "775-782-0700",
            "fax_number": "778-782-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPINE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-11",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "VANDIVER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "775-782-0700"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minden Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minden Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minden, NV

Sources for this page

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