Courtney C. Gwinn, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD60979303 Issued in WA

Practice address

1959 NE Pacific St
Room BB-527
Seattle, WA 98195-6421

Phone

(206) 543-3605

NPI assigned

Apr 13, 2016

Last updated

Jun 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

DermatologyAlso: Micrographic Dermatologic Surgery (MDS)

Education

University of Washington School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, shared by 7 NPIs, 103 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cgwinn608502@direct.multicare.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountain West Derm - Blackhart PLLC

  dba Advanced Dermatology & Skin Surgery

  • Dermatology Physician
  • Spokane Valley, WA
  • NPI 1013557933
  Medicare reassignment NPD
• Mountain West Derm - Blackhart PLLC

  dba Advanced Dermatology & Skin Surgery

  • Ambulatory Surgical Clinic/Center
  • Spokane Valley, WA
  • NPI 1619517539

  ID

  Medicare reassignment NPD
• Mountain West Derm-Blackhart, PLLC

  dba Dermatology Clinic of Idaho

  • Dermatology Physician
  • Boise, ID
  • NPI 1548758501
  Medicare reassignment NPD
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Tigard, OR
  • NPI 1316656994
  NPD
• Dermatology Associates,P.C.

  • Specialist
  • Tigard, OR
  • NPI 1851442461
  NPD (past)

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1508210741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 N HUTCHINSON RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992122444",
            "telephone_number": "206-543-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 NE PACIFIC ST",
            "address_2": "ROOM BB-527",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981956421",
            "telephone_number": "206-543-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWINN",
        "first_name": "COURTNEY",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD60979303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Marie Guzman, LSWAIC
• Gwen Wilson PLLC (Gwen Wilson Counseling and Art Therapy Services)
• Gwenyth McConnell MD (Appartenance Psychiatry, Inc.)
• William Rayford Gwin III, MD
• Andrew James Gwinn, MA
• Micah Gwinn
• Ryder P Gwinn, MD
• Alex Gwozda, LMP
• Iisha Gwynn
• Tashi D Gyaltsong, MD

• Dermatology Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.