Providence Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PROVIDENCE DERMATOLOGY LLC

Practice address

169 N Gateway Dr Ste 100
Providence, UT 84332-9860

Phone

(541) 999-4475

NPI assigned

May 22, 2019

Organization subpart

No

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

Authorized official

Name

Travis S James, DONPI 1477818920

Title

Owner/Physician

Phone

(435) 554-1182

Specialties & licenses 2

Addresses

Other names 1

• Providence Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00355

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Travis James, DO

  • Dermatology Physician
  • Providence, UT
  • NPI 1477818920
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1568029957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 N GATEWAY DR STE 100",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329860",
            "telephone_number": "435-554-1182",
            "fax_number": "435-554-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 N GATEWAY DR STE 100",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329860",
            "telephone_number": "541-999-4475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "950 Medical Dr Ste 311",
            "address_purpose": "LOCATION",
            "city": "Brigham City",
            "state": "UT",
            "postal_code": "843024724",
            "country_code": "US",
            "telephone_number": "435-554-1182",
            "fax_number": "435-554-1950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-22",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "435-554-1182",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sherrie Petty
• Camille Porter
• Primrose Home Care Inc.
• Primrose Hospice Inc.
• Providence City, LLC
• Providence PDC PLLC
• Aariah Lee Pugsley, RBT
• Quantum Healthcare LLC
• Leighanne Quarles, APRN, PMHNP-BC
• Emma Lucille Queen, RBT

• 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 Jun 16, 2025; 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.