Forefront Dermatology SC
Organization Active NPI Dermatology Physician · Fort Wayne, IN
NPI 1578097572 · NPPES record last updated Aug 28, 2026
Key facts
- NPI
- 1578097572
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- FOREFRONT DERMATOLOGY SC
- Practice address
- 4020 New Vision Dr
Fort Wayne, IN 46845-1737 - Phone
- (260) 423-2567
- Fax
- (260) 420-2415
- NPI assigned
- Apr 17, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Betsy J Wernli, MD
- Title
- President
- Phone
- (920) 482-0671
Other NPIs on the same Medicare enrollment 24
Practitioners 4
-
Rohit Kakar, M.D.
-
Elyssa Ann Pittenger, FNP-BC
-
Michael C Chen, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D1020689 | Forefront Dermatology, SC | Compliance | Mar 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140425001640 | IN | Part B Supplier - Clinic/Group Practice | 3779471701 |
Receives reassigned benefits from 44 practitioners 24 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kokomo, IN; Marion, IN; Mooresville, IN; Noblesville, IN; Salem, IN; Crown Point, IN; Scottsburg, IN; Seymour, IN… |
National Provider Directory
Locations
4020 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 423-2567
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Procedural Dermatology Physician |
207NS0135X |
Addresses
Primary practice location
4020 New Vision Dr
Fort Wayne, IN 46845-1737
Mailing address
801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008
Other providers in Fort Wayne, IN
- Melissa Ann Ford
- Rebecca L Ford
- Robert Anthony Ford
- Tricia Louise Ford
- Cindy M Fordyce
- Forefront Dermatology, S.C.
- Forensic Nursing Specialties, Inc
- Raphael Fredrick Forestieri
- Cory Lee Fornal
- Dana R Forrest
All providers in Fort Wayne, IN · Dermatology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.