Innovative Wound Healing & Dermatology

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INNOVATIVE WOUND HEALING & DERMATOLOGY

Practice address

21137 Sr 410 E Ste I
Bonney Lake, WA 98391-8775

Phone

(800) 425-2805

Fax

(855) 673-1403

NPI assigned

Apr 23, 2021

Last updated

Sep 16, 2024By 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

Daniel Levy, MDNPI 1306067814

Title

Provider

Phone

(800) 425-2805

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00164

Practitioners 9

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.

• Daniel Levy, MD

  • Dermatology Physician
  • Bonney Lake, WA
  • NPI 1306067814
  Medicare reassignment Authorized official
• Lance Alfred Nethercott, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Puyallup, WA
  • NPI 1891119129
  Medicare reassignment NPD
• Zachary Zan Stanfield, DPM

  • Foot & Ankle Surgery Podiatrist
  • Bonney Lake, WA
  • NPI 1588010359
  Medicare reassignment NPD
• Quyen T Stevenson, ARNP

  • Nurse Practitioner
  • Seattle, WA
  • NPI 1497988505
  Medicare reassignment NPD
• Tory James Foss, PA-C

  • Physician Assistant
  • Tacoma, WA
  • NPI 1881086379
  Medicare reassignment
• Ricardo Melendrez Jr., PA-C

  • Medical Physician Assistant
  • West Richland, WA
  • NPI 1962956185
  Medicare reassignment
• Alison M Stinnett, PA

  • Physician Assistant
  • Poulsbo, WA
  • NPI 1427066323
  Medicare reassignment
• Gabriel David Alonso, APRN

  • Adult Health Nurse Practitioner
  • San Antonio, TX
  • NPI 1659981066
  NPD
• Andrea Lynn Herrera, P.A.

  • Medical Physician Assistant
  • El Paso, TX
  • NPI 1700017530
  NPD (past)

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

{
    "created_epoch": "1619136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1538741053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21137 SR 410 E STE I",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918775",
            "telephone_number": "800-425-2805",
            "fax_number": "855-673-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21137 SR 410 E STE I",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918775",
            "telephone_number": "800-425-2805",
            "fax_number": "855-673-1403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "414 Babcock Rd",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782013120",
            "country_code": "US",
            "telephone_number": "800-494-7759",
            "fax_number": "253-750-5151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNOVATIVE WOUND HEALING & DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-23",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "LEVY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "800-425-2805",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John D Huynh, D.C.
• Muktar I Sheko
• Selina Ibarra, RBT
• Ichiro PLLC (Ideal Motion Chiropractic)
• Michellynn Inglin, LMP
• Integrated Rehabilitation Group, PC (IRG Physical & Hand Therapy Bonney Lake)
• Isaac Fu DDS PLLC
• Michelle Christine Jackson, ARNP
• Daniel M James, PHARM. D.
• Marcie Lynn Jantz, RN

• Dermatology Physician in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.