Mountain Pine Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

O-0934 Issued in ID

Legal business name

MOUNTAIN PINE DERMATOLOGY, PLLC

Practice address

4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442

Phone

(208) 898-7467

NPI assigned

Aug 30, 2016

Last updated

Jul 5, 2020By 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. Richard Scott Thomas, D.O.NPI 1265795660

Title

Owner

Phone

(208) 250-7433

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, OR2 enrollments

Enrollment records 2

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

Practitioners 10

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.

• Richard Scott Thomas, D.O.

  • Dermatology Physician
  • Meridian, ID
  • NPI 1265795660

  OR

  Medicare reassignment Care Compare group Authorized official
• Avery Dinallo, DNP, APN, FNP-C

  • Family Nurse Practitioner
  • Meridian, ID
  • NPI 1902328404
  Medicare reassignment Care Compare group NPD
• Vienna Grayce Katana, DO

  • Dermatology Physician
  • Meridian, ID
  • NPI 1871832881
  Medicare reassignment Care Compare group NPD
• Nadezhda Kravchuk, NP-C

  • Nurse Practitioner
  • Nampa, ID
  • NPI 1033686076
  Medicare reassignment Care Compare group NPD
• Benjamin Merrill Perry, D.O.

  • Dermatology Physician
  • Meridian, ID
  • NPI 1710325758

  OR

  Medicare reassignment Care Compare group NPD
• Jennifer Wicklund, FNP-C

  • Family Nurse Practitioner
  • Meridian, ID
  • NPI 1871165118

  OR

  Medicare reassignment Care Compare group NPD
• Ladessa Marie Christensen, NP-C

  • Family Nurse Practitioner
  • Meridian, ID
  • NPI 1215367685
  Medicare reassignment Care Compare group
• Chelsea Miller, PA-C

  • Physician Assistant
  • Meridian, ID
  • NPI 1043659196
  Medicare reassignment Care Compare group
• William Lorin Taylor III, PA-C

  • Physician Assistant
  • Pocatello, ID
  • NPI 1164152401
  Medicare reassignment Care Compare group
• Brianna Thomson, PA-C

  • Physician Assistant
  • Boise, ID
  • NPI 1487388997
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593907200000",
    "number": "1659827665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN PINE DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-30",
        "last_updated": "2020-07-05",
        "certification_date": "2020-07-05",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-250-7433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "ID",
            "license": "O-0934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angie Moses, LMFT
• Stanley Warren Moss, M.D.
• Cecilia Rosalie Motschenbacher, FNP-C
• Georgia Rebecca Motyer
• Marlee Motyer, PHARMD
• Mountain Valley Counseling LLC
• Mountain View Pointe Dental
• Mountain View Surgery Center
• Mountain West Medical Services PLLC
• Mountain West Spine LLC

• Dermatology Physician in Meridian, ID
• Providers in Meridian, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2020; 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.