LP Derm LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LP DERM LLC

Doing business as

Lone Pine Dermatology

Practice address

517 W 100 N Ste 103
Providence, UT 84332-9824

Phone

(435) 554-8442

NPI assigned

Jan 30, 2023

Last updated

Jan 30, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

LP DERM LLCAs reported in NPPES

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

Authorized official

Name

Cory B Maughan, DONPI 1598086720

Title

Owner

Phone

(435) 554-8442

Specialties & licenses 2

Addresses

Other names 1

• Lone Pine Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in UT, ID2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Part of

Lone Pine Dermatology

Locations

Practitioners 3

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.

• Cory B Maughan, D.O.

  • MOHS-Micrographic Surgery Physician
  • Providence, UT
  • NPI 1598086720

  Dermatology, ID

  Medicare reassignment Care Compare group NPD Authorized official
• Heather B Allred, PA-C

  • Physician Assistant
  • Providence, UT
  • NPI 1104859149

  ID

  Medicare reassignment Care Compare group
• Phillip E Stevenson, PA-C

  • Physician Assistant
  • Payette, ID
  • NPI 1871744425

  UT

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1538875786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 W 100 N STE 103",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329824",
            "telephone_number": "435-554-8442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 W 100 N STE 103",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329824",
            "telephone_number": "435-554-8442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 N 600 E Ste 101",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843416743",
            "country_code": "US",
            "telephone_number": "435-554-8442",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "970 Medical Dr Ste 311",
            "address_purpose": "LOCATION",
            "city": "Brigham City",
            "state": "UT",
            "postal_code": "843023284",
            "country_code": "US",
            "telephone_number": "435-554-8442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LP DERM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LP DERM LLC",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "MAUGHAN",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-554-8442",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Pine Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Grace Lords, PT,DPT
• Lori C. Novich-Welter, M.D., P.C.
• Robert William Pedro Lyday, DO
• Brian Thomas Lyman, D.C.
• Abigail Lyon, RBT
• Candice Elizabeth Macari, PA-C
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• Dermatology Physician in Providence, UT
• Providers in Providence, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.