Blair Walter Harris, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2022-02190 Issued in NC

Practice address

509 Olde Waterford Way Ste 103
Leland, NC 28451-4126

Phone

(910) 631-0301

Fax

(910) 292-1230

NPI assigned

Mar 7, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Pacific NW Un of HS, Col of Osteopathic Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intracoastal Dermatology and Skin Surgery PLLCGroup PAC ID 3678924693, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bharris@intracoastaldermatology.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Intracoastal Dermatology and Skin Surgery PLLC

  • Dermatology Physician
  • Leland, NC
  • NPI 1871375055
  Medicare reassignment Care Compare group NPD Authorized official
• Atlantic Dermatology, PA

  • Dermatology Physician
  • Wilmington, NC
  • NPI 1871043109
  NPD (past)
• Anne Arundel Dermatology Affiliates PC

  • Dermatology Physician
  • Hunt Valley, MD
  • NPI 1083200794
  NPD (past)

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

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1376001479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 OLDE WATERFORD WAY STE 103",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284514126",
            "telephone_number": "910-631-0301",
            "fax_number": "910-292-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 OLDE WATERFORD WAY STE 103",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284514126",
            "telephone_number": "910-631-0301",
            "fax_number": "910-292-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "BLAIR",
        "middle_name": "WALTER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-07",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NC",
            "license": "2022-02190",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2022-02190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Joy Hanshaw, OTR/L
• Monyetta Hanson
• Ricque A Hardin
• Craig John Hare, PA
• Harris Teeter LLC (Harris Teeter Pharmacy #225)
• Cassandra Hartell, DNP, CNM, WHNP-BC
• Daniel Jesson Hartley, DNP, FNP-BC, APRN
• Deborah A Hayden, O.D.
• Healing Is Possible PLLC
• Healthcare Business Reps LLC

• Dermatology Physician in Leland, NC
• Providers in Leland, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.