S. Albertson Dermatology and Skin Cancer Center LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

S. ALBERTSON DERMATOLOGY AND SKIN CANCER CENTER LLC

Practice address

2375 E Sunnyside Rd Ste J
Idaho Falls, ID 83404-8281

Phone

(208) 589-3918

NPI assigned

May 12, 2021

Organization subpart

No

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

Authorized official

Name

Stetson Albertson, DONPI 1427579929

Title

Manager

Phone

(208) 589-3918

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

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

• Stetson Albertson, DO

  • Dermatology Physician
  • Warren, MI
  • NPI 1427579929

  ID

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1316521602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 E 2350 N",
            "city": "HAMER",
            "state": "ID",
            "postal_code": "834254900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 E SUNNYSIDE RD STE J",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048281",
            "telephone_number": "208-589-3918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S. ALBERTSON DERMATOLOGY AND SKIN CANCER CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "ALBERTSON",
        "authorized_official_first_name": "STETSON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-589-3918",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daric J Russell, DO
• Sarah Lynn Russell, BSW, LMSW
• Lisa J Russom, LSW
• Orin Kelley Ryan, DPT
• Rhonda Ryan, L.M.T.
• S&G Home Health LLC
• S&G Hospice of Idaho LLC
• Katie K Sacco, LPC
• Angela J Sackett, D.C.
• Maryam Sadeghi

• MOHS-Micrographic Surgery Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• MOHS-Micrographic Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; 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.