NPIMap

Organization Active NPI

Forefront Dermatology, S.C.

Doing business as Advanced Dermatology & Skin Care Centre

  • Dermatology Physician
  • Mobile, AL
National Provider Identifier
1366936759
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOREFRONT DERMATOLOGY, S.C.
Doing business as
Advanced Dermatology & Skin Care Centre
Practice address
580 Providence Park Dr E
Mobile, AL 36695-4614
Phone
(251) 631-3570
Fax
(251) 631-3572
NPI assigned
Jun 19, 2018
Last updated
Aug 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

580 Providence Park Dr E
Mobile, AL 36695-4614

Mailing address

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

Other practice location 1

8573 County Road 64
Daphne, AL 36526-8706
Phone (251) 621-2244

Other practice location 2

2305 Hand Ave
Bay Minette, AL 36507-4191
Phone (251) 631-3570

Other names 1

  • Advanced Dermatology & Skin Care Centre Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180911002840 AL Part B Supplier - Clinic/Group Practice 3779471701 Receives reassigned benefits from 48 practitioners
7 other NPIs on this enrollment
Practice locations: Oxford, AL; Oneonta, AL; Mountain BRK, AL; Mobile, AL; Leeds, AL; Gardendale, AL; Florence, AL; Fairhope, AL…

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0918760Forefront Dermatology, SC8573 County Road 64, Daphne, AL 36526ComplianceApr 4, 2027

National Provider Directory

National Provider Directory

Locations

Bin 88617
Milwaukee, WI 53288

Practitioners & affiliated clinicians

Practitioners 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1366936759",
    "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": "580 PROVIDENCE PARK DR E",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366954614",
            "telephone_number": "251-631-3570",
            "fax_number": "251-631-3572"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8573 County Road 64",
            "address_purpose": "LOCATION",
            "city": "Daphne",
            "state": "AL",
            "postal_code": "365268706",
            "country_code": "US",
            "telephone_number": "251-621-2244",
            "fax_number": "251-621-7209",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2305 Hand Ave",
            "address_purpose": "LOCATION",
            "city": "Bay Minette",
            "state": "AL",
            "postal_code": "365074191",
            "country_code": "US",
            "telephone_number": "251-631-3570",
            "fax_number": "251-631-3572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology & Skin Care Centre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.