NPIMap

Organization Active NPI

Montana Skin Cancer and Dermatology Center, P.C.

  • Dermatology Physician
  • Bozeman, MT
National Provider Identifier
1487082087
Registry record updated Mar 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
20664 Issued in MT
Legal business name
MONTANA SKIN CANCER AND DERMATOLOGY CENTER, P.C.
Practice address
1905 W College St
Bozeman, MT 59718-4061
Phone
(406) 587-4432
Fax
(406) 587-7015
NPI assigned
Oct 17, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2023

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

Authorized official

Name
Jennifer Raasch, CPB
Title
Billing Manager
Phone
(406) 587-4432

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 20664 MT Primary

Addresses

Primary practice location

1905 W College St
Bozeman, MT 59718-4061

Mailing address

1905 W College St
Bozeman, MT 59718-4061
Phone (406) 587-4432

Other names 1

  • SkinCare MT Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140304002135 MT Part B Supplier - Clinic/Group Practice 1456581859 Receives reassigned benefits from 9 practitioners
Practice locations: Bozeman, MT

National Provider Directory

National Provider Directory

Locations

1905 W College St
Bozeman, MT 59718
Phone (406) 490-9953

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1487082087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 W COLLEGE ST",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597184061",
            "telephone_number": "406-587-4432",
            "fax_number": "406-587-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 W COLLEGE ST",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597184061",
            "telephone_number": "406-587-4432",
            "fax_number": "406-587-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTANA SKIN CANCER AND DERMATOLOGY CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-17",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "RAASCH",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "406-587-4432",
        "authorized_official_credential": "CPB"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MT",
            "license": "20664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SkinCare MT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.