NPIMap

Organization Active NPI

Dermatology Health Specialists, PC

  • Dermatology Physician
  • Bend, OR
National Provider Identifier
1447713573
Registry record updated Apr 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY HEALTH SPECIALISTS, PC
Practice address
1693 SW Chandler Ave Ste 250
Bend, OR 97702-3231
Phone
(210) 632-5544
NPI assigned
Apr 6, 2019
Last updated
Apr 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2019

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

Authorized official

Name
Oliver Wisco, DONPI 1164545166
Title
President
Phone
(210) 632-5544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

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

Addresses

Primary practice location

1693 SW Chandler Ave Ste 250
Bend, OR 97702-3231

Mailing address

PO Box 831
Bend, OR 97709-0831
Phone (210) 632-5544

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190618001978 OR Part B Supplier - Clinic/Group Practice 7214260603 Receives reassigned benefits from 7 practitioners
Practice locations: Bend, OR; La Pine, OR; Madras, OR; Redmond, OR

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
38D2168478Dermatology Health Specialists - Bend1693 SW Chandler Drive, Suite 250, Bend, OR 97702ComplianceOct 20, 2027

National Provider Directory

National Provider Directory

Locations

2565 NW Lovejoy St
Ste 100
Portland, OR 97210
Phone (503) 279-9700

Practitioners & affiliated clinicians

Practitioners 12

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": "1554508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554508800000",
    "number": "1447713573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 831",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977090831",
            "telephone_number": "210-632-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1693 SW CHANDLER AVE STE 250",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023231",
            "telephone_number": "210-632-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY HEALTH SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-06",
        "last_updated": "2019-04-06",
        "status": "A",
        "authorized_official_last_name": "WISCO",
        "authorized_official_first_name": "OLIVER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-632-5544",
        "authorized_official_credential": "DO"
    },
    "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2019; 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.