NPIMap

Individual provider Active NPI

Carrick Burns

  • Dermatology Physician
  • Corvallis, OR
National Provider Identifier
1578791901
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD209898 Issued in OR
Practice address
2430 NW Professional Dr
Corvallis, OR 97330-3991
Phone
(415) 452-0180
NPI assigned
Jun 24, 2009
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD209898 OR Primary
MOHS-Micrographic Surgery Physician 207ND0101X MD209898 OR

Addresses

Primary practice location

2430 NW Professional Dr
Corvallis, OR 97330-3991

Mailing address

2430 NW Professional Dr
Corvallis, OR 97330-3991
Phone (541) 452-0180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220714002209 OR Practitioner - DermatologyPractitioner - Micrographic Dermatologic Surgery (MDS) 9830523539 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
DermatologyAlso: Micrographic Dermatologic Surgery (MDS)
Education
Tulane University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2430 NW Professional Dr
Corvallis, OR 97330-3991
Phone (541) 452-0180

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.31 of 100Reported as group
Quality
90.62
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision73
Removal of skin lesions461
Removal of skin cancer425
Removal or shaving of skin growth1-10
Skin biopsy153

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Brune Dermatology, LLC Dermatology CurrentSince Aug 1, 2022 Accepting new patients
Fair Winds Dermatology LLC Dermatology CurrentSince Apr 1, 2024 Accepting new patients

Locations

1740 NW 9th St
Corvallis, OR 97330
Phone (541) 230-1350

2430 NW Professional Dr
Corvallis, OR 97330
Phone (541) 230-1350

Interoperability endpoints

  • Direct secure messaging: cburns@fairwindsderm.emadirect.md

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 51

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1578791901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 NW PROFESSIONAL DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303991",
            "telephone_number": "541-452-0180",
            "fax_number": "541-427-4435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 NW PROFESSIONAL DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303991",
            "telephone_number": "415-452-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNS",
        "first_name": "CARRICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-24",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD209898",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "OR",
            "license": "MD209898",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.