Black Hills Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0370 Issued in SD

Legal business name

BLACK HILLS DERMATOLOGY PC

Doing business as

Black Hills Dermatology and Laser Surgery Centre

Practice address

7236 Jordan Drive Suite 101
Rapid City, SD 57702-8740

Phone

(605) 341-5565

Fax

(605) 341-5595

NPI assigned

Feb 7, 2006

Last updated

May 20, 2008By 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

Mr. Jason W Gorman

Title

Administrator

Phone

(605) 341-5565

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Black Hills Dermatology and Laser Surgery Centre Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Black Hills Dermatology PC

  • Dermatology Physician
  • Spearfish, SD
  • NPI 1689831091

  O20040602001407

  Same enrollment

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

CLIA laboratory certificates

Tax ID family

Black Hills Derm and Laser Surgery Cente2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Black Hills Dermatology PC

  • Dermatology Physician
  • Spearfish, SD
  • NPI 1689831091
  NPD tax ID

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.60043

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.

• Anna Gagliano, NP-C

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1760040190
  Medicare reassignment Care Compare group NPD
• Julie A Krein, CNP

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1700858263
  Medicare reassignment Care Compare group NPD
• Ericka L. Privitt, N.P.

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1154703817
  Medicare reassignment Care Compare group NPD
• Vassilia D Young, MD

  • Dermatology Physician
  • Rapid City, SD
  • NPI 1750353389
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1497727028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7236 JORDAN DRIVE SUITE 101",
            "address_2": "PO BOX 6540",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577096540",
            "telephone_number": "605-341-5565",
            "fax_number": "605-341-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7236 JORDAN DRIVE SUITE 101",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028740",
            "telephone_number": "605-341-5565",
            "fax_number": "605-341-5595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "GORMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-341-5565",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SD",
            "license": "0370",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "SD",
            "license": "0370",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "SD",
            "license": "0370",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "SD",
            "license": "0370",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS NUMBER",
            "identifier": "0040885",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Hills Dermatology and Laser Surgery Centre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Black Hills Behavior, LLC (Impact Learning & Development)
• Black Hills Care and Rehabilitation Center LLC (Black Hills Care and Rehabilitation Center)
• Black Hills Caregiving, LLC
• Black Hills Center for Healing and Advancement of Psychotherapy PLC
• Black Hills Child Psychiatric Services (Black Hills Child Psychiatrc Services)
• Black Hills Embrace LLC
• Black Hills Healing Arts Inc
• Black Hills Health and Wellness Center of Rapid Ci
• Black Hills Health Care System
• Black Hills Hearing Health

• Dermatology Physician in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Dermatology Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.