Anchorage Dermatology & Cosmetics, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ANCHORAGE DERMATOLOGY & COSMETICS, LLC

Practice address

615 E 82ND Ave Ste 204
Anchorage, AK 99518-3159

Phone

(907) 865-8455

Fax

(907) 865-8464

NPI assigned

Jul 31, 2019

Last updated

Jan 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Courtney Weathersby Bagayoko, M.D.NPI 1235472176

Title

Authorized Official

Phone

(626) 353-3885

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

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_00011

Practitioners 6

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.

• Courtney Weathersby Bagayoko, M.D.

  • Dermatology Physician
  • Anchorage, AK
  • NPI 1235472176
  Medicare reassignment Care Compare group NPD Authorized official
• Rechelle Tull, MD

  • MOHS-Micrographic Surgery Physician
  • Anchorage, AK
  • NPI 1679008767

  Dermatology

  Medicare reassignment Care Compare group NPD
• Jodie Brewer, PA-C

  • Physician Assistant
  • Anchorage, AK
  • NPI 1609120013
  Medicare reassignment Care Compare group
• Roy E Howard, PA-C

  • Medical Physician Assistant
  • Anchorage, AK
  • NPI 1689667586
  Medicare reassignment Care Compare group
• Alisha Marie Jennings

  • Physician Assistant
  • Anchorage, AK
  • NPI 1699387746
  Medicare reassignment Care Compare group
• Lauren Ashley Poulsen, PA-C

  • Physician Assistant
  • Anchorage, AK
  • NPI 1558640607
  Medicare reassignment NPD

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641168000000",
    "number": "1609420215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 E 82ND AVE STE 204",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995183159",
            "telephone_number": "907-865-8455",
            "fax_number": "913-246-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 E 82ND AVE STE 204",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995183159",
            "telephone_number": "907-865-8455",
            "fax_number": "907-865-8464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 E 82nd Ave Ste 302",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995183159",
            "country_code": "US",
            "telephone_number": "907-865-8455",
            "fax_number": "913-246-4901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANCHORAGE DERMATOLOGY & COSMETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A",
        "authorized_official_last_name": "BAGAYOKO",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "WEATHERSBY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "626-353-3885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anchorage Community Mental Health Services, Inc (Alaska Behavioral Health)
• Anchorage Community Mental Health Services, Inc (Alaska Behavioral Health)
• Anchorage Community Mental Health Services, Inc (Alaska Behavioral Health)
• Anchorage Community Mental Health Services, Inc
• Anchorage Dental Care, LLC
• Anchorage Doctors Incorporated (Alpine Urgent Care)
• Anchorage Endoscopy Center, LLC
• Anchorage Endoscopy Surgicenter, LLC (Anchorage Endoscopy Center)
• Anchorage Family Chiropractic PC
• Anchorage Foot and Ankle Clinic, LLC

• Dermatology Physician in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Dermatology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.