Active NPI
Forefront Dermatology, S.C.
- Dermatology Physician
- Kenosha, WI
National Provider Identifier
1548716533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- FOREFRONT DERMATOLOGY, S.C.
- Practice address
- 3601 30TH Ave
Suite 201
Kenosha, WI 53144 - Phone
- (262) 898-4400
- Fax
- (262) 658-0149
- NPI assigned
- Aug 30, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Betsy J Wernli, MD
- Title
- President
- Phone
- (920) 482-0671
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary | ||
| Procedural Dermatology Physician | 207NS0135X |
Addresses
Primary practice location
3601 30TH Ave
Suite 201
Kenosha, WI 53144
Mailing address
801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040310000252 | WI | Part B Supplier - Clinic/Group Practice | 3779471701 |
Receives reassigned benefits from 83 practitioners This NPI is an additional NPI on the enrollment Practice locations: Mount Pleasant, WI; Neenah, WI; New London, WI; New Richmond, WI; Oak Creek, WI; Oconomowoc, WI; Oconto Falls, WI; Oshkosh, WI… |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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.
-
- Dermatology Physician
- Pleasant Prairie, WI
- NPI 1154504017
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472515200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1526428800000",
"number": "1548716533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 YORK ST",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542204630",
"telephone_number": "920-663-9005",
"fax_number": "920-682-0970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 30TH AVE",
"address_2": "SUITE 201",
"city": "KENOSHA",
"state": "WI",
"postal_code": "53144",
"telephone_number": "262-898-4400",
"fax_number": "262-658-0149"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOREFRONT DERMATOLOGY, S.C.",
"organizational_subpart": "NO",
"enumeration_date": "2016-08-30",
"last_updated": "2018-05-16",
"status": "A",
"authorized_official_last_name": "WERNLI",
"authorized_official_first_name": "BETSY",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "920-482-0671",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
},
{
"code": "207NS0135X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Procedural Dermatology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Kenosha, WI
- Patricia Eleanor Fons
- Foot & Ankle Health Care SC
- Foot Factor Podiatry LLC
- Forefront Dermatology, S.C.
- Forefront Dermatology, S.C.
- Foresight Optical Inc (Kindy Sterling Optical)
- Imelda N Forsberg, NURSE PRACTITIONER
- Katarzyna Anna Fortuna-Garcia, PHARMD
- Nora Foshager, M.S., CF-SLP
- Nathaniel Foss, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; 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.