Premier Dermatology, LTD.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PREMIER DERMATOLOGY, LTD.

Practice address

3741 Pheasant LN
Waterloo, IA 50701-5215

Phone

(319) 234-6000

Fax

(319) 234-6001

NPI assigned

May 21, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Justin C Ellerbroek, M.D.NPI 1790981207

Title

Owner

Phone

(319) 233-3044

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Justin Craig Ellerbroek, M.D.

  • Dermatology Physician
  • Waterloo, IA
  • NPI 1790981207
  Medicare reassignment Care Compare group NPD Authorized official
• Alena Davida Ellerbroek, MSN,FNP

  • Family Nurse Practitioner
  • Waterloo, IA
  • NPI 1376858654
  Medicare reassignment Care Compare group NPD
• Eric M Dolash, PA-C

  • Physician Assistant
  • Waterloo, IA
  • NPI 1497162143
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1467898007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2400",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042400",
            "telephone_number": "319-234-6000",
            "fax_number": "319-234-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3741 PHEASANT LN",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015215",
            "telephone_number": "319-234-6000",
            "fax_number": "319-234-6001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "312 9th St SW Ste 2000",
            "address_purpose": "LOCATION",
            "city": "Waverly",
            "state": "IA",
            "postal_code": "506772909",
            "country_code": "US",
            "telephone_number": "319-234-6000",
            "fax_number": "319-234-6001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER DERMATOLOGY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-21",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "ELLERBROEK",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-233-3044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer J Powell, LISW
• Steven Brian Powell, M.D.
• Corinne Powers
• Pragmatic Transportation
• Robert Stephen Pranger, MD
• Brieanna Priebe
• Joshua Priebe
• Professional Compounding Center of Iowa, Inc. (Greenwood Compounding Pharmacy)
• Alyssa Maria Prohaski, LMSW
• Mary Susan Pruzinsky, MD

• Dermatology Physician in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Dermatology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.