Fair Winds Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

FAIR WINDS DERMATOLOGY LLC

Practice address

2430 NW Professional Dr
Corvallis, OR 97330-3991

Phone

(541) 230-1350

NPI assigned

Mar 11, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Katie Hatsushi, MD

Title

Office Manager

Phone

(408) 480-7500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Practitioners 2

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

• Carrick Burns

  • Dermatology Physician
  • Corvallis, OR
  • NPI 1578791901
  Medicare reassignment NPD
• Adriana M. Brune, MD

  • Dermatology Physician
  • Corvallis, OR
  • NPI 1699743062
  NPD

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1639937170",
    "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": "541-230-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR WINDS DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "HATSUSHI",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "408-480-7500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kay Ewing, OT
• Ainsley Nicholle Ezra
• Dawniel Facque
• David M. Faddis, M.D., FACS
• Isabel Fagoaga, LMT
• Emily Ann Fairchild
• Faith, Hope and Charity
• Carlie Falk
• Crystal Lynn Falk, MTH
• Elizabeth Falls

• Dermatology Physician in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.