NPIMap

Organization Active NPI

Forefront Dermatology, S.C.

Doing business as Premier Dermatology

  • Dermatology Physician
  • Naperville, IL
National Provider Identifier
1376915629
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOREFRONT DERMATOLOGY, S.C.
Doing business as
Premier Dermatology
Practice address
1520 Bond St
Naperville, IL 60563
Phone
(630) 357-7536
Fax
(630) 904-0413
NPI assigned
Oct 27, 2015
Last updated
May 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Authorized official

Name
Dr. Betsy J Wernli, MD
Title
President
Phone
(920) 482-0671

Specialties & licenses 3

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

Addresses

Primary practice location

1520 Bond St
Naperville, IL 60563

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9016

Other names 1

  • Premier Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151130001424 IL Part B Supplier - Clinic/Group Practice 3779471701 Receives reassigned benefits from 51 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Libertyville, IL; Lincolnshire, IL; Moline, IL; Morris, IL; Naperville, IL; New Lenox, IL; O Fallon, IL; Park Ridge, IL…

Other NPIs on the same Medicare enrollment 21

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

View all 21

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
14D1037339Premier Dermatology1520 Bond St, Naperville, IL 60563ComplianceJun 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Forefront Dermatology SC121 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

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": "1445904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1376915629",
    "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": "920-663-9016",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 BOND ST",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "60563",
            "telephone_number": "630-357-7536",
            "fax_number": "630-904-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-27",
        "last_updated": "2018-05-17",
        "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 SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.