Clinic for Dermatology & Wellness LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

CLINIC FOR DERMATOLOGY & WELLNESS LLC

Practice address

2924 Siskiyou Blvd Ste 200
Medford, OR 97504-6462

Phone

(541) 200-2793

NPI assigned

Aug 26, 2016

Last updated

Jun 19, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph John Atzenbeck

Title

Chief Executive Officer

Phone

(541) 200-2777

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 8

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.

• Nikki Danielle Ying Tang, M.D.

  • MOHS-Micrographic Surgery Physician
  • Medford, OR
  • NPI 1740574169
  Medicare reassignment Care Compare group NPD
• Curtis Lamar Hardy, D.O.

  • Dermatology Physician
  • Chapin, SC
  • NPI 1326469743

  OR, Single Specialty

  Medicare reassignment Care Compare group NPD
• Kevin Wright, M.D.

  • Dermatology Physician
  • San Diego, CA
  • NPI 1164700738

  OR

  Medicare reassignment Care Compare group NPD
• Liesel Ernst

  • Physician Assistant
  • Medford, OR
  • NPI 1417226382
  Medicare reassignment Care Compare group
• Joseph Rocco Gatti, PA-C

  • Physician Assistant
  • Medford, OR
  • NPI 1801101100
  Medicare reassignment Care Compare group
• Kelly L Mead, PA-C

  • Medical Physician Assistant
  • Enfield, CT
  • NPI 1275607855

  OR

  Medicare reassignment Care Compare group
• Lawrence D Weidell, PA-C

  • Medical Physician Assistant
  • Panama City, FL
  • NPI 1770540122

  OR

  Medicare reassignment
• Anya Elizabeth Bandt, M.D.

  • Dermatology Physician
  • Medford, OR
  • NPI 1750401998
  NPD

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624060800000",
    "number": "1467908863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2924 SISKIYOU BLVD STE 200",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046462",
            "telephone_number": "541-200-2777",
            "fax_number": "541-214-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2924 SISKIYOU BLVD STE 200",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046462",
            "telephone_number": "541-200-2793"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2937 Siskiyou Blvd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975048100",
            "country_code": "US",
            "telephone_number": "541-200-2777",
            "fax_number": "541-214-2575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLINIC FOR DERMATOLOGY & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2021-06-19",
        "certification_date": "2021-06-19",
        "status": "A",
        "authorized_official_last_name": "ATZENBECK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "541-200-2777"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barry Andrew Clegg, O.D.
• Brandon Clegg, PHARM D
• Robin Clevenger
• Todd A Clevenger, MD
• Hannah Cline
• Ally Jo Clodfelter
• Alisa Kay Cloud, LMT
• James Christopher Cloud, M.S., QMHP, CADC I
• Jim Cloward, PT
• Cloyd Family Vision LLC (Riverside Vision Care)

• Family Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2021; 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.