Black Hills Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0370 Issued in SD

Legal business name

BLACK HILLS DERMATOLOGY PC

Practice address

132 E Grant St
Spearfish, SD 57783-2424

Phone

(605) 722-9090

Fax

(605) 722-9909

NPI assigned

May 22, 2008

Last updated

Jan 30, 2015By 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

Mr. Jason W Gorman

Title

Administrator

Phone

(605) 341-5565

Specialties & licenses 4

Addresses

Other names 1

• Spearfish Clinic Other name

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Black Hills Dermatology PC

  dba Black Hills Dermatology and Laser Surgery Centre

  • Dermatology Physician
  • Rapid City, SD
  • NPI 1497727028

  O20040602001407

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Black Hills Derm and Laser Surgery Cente2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Black Hills Dermatology PC

  dba Black Hills Dermatology and Laser Surgery Centre

  • Dermatology Physician
  • Rapid City, SD
  • NPI 1497727028
  NPD tax ID

Locations

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.

• Anna Gagliano, NP-C

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1760040190
  NPD
• Julie A Krein, CNP

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1700858263
  NPD
• Ericka L. Privitt, N.P.

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1154703817
  NPD
• Vassilia D Young, MD

  • Dermatology Physician
  • Rapid City, SD
  • NPI 1750353389
  NPD
• Chantel J Holz

  • Nurse Practitioner
  • Rapid City, SD
  • NPI 1295042075
  NPD (past)
• Susan A Matthew, CNP

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1356313811
  NPD (past)

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422576000000",
    "number": "1689831091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6540",
            "address_2": "7236 JORDAN DRIVE STE 101",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577096540",
            "telephone_number": "605-341-5565",
            "fax_number": "605-341-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 E GRANT ST",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832424",
            "telephone_number": "605-722-9090",
            "fax_number": "605-722-9909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2015-01-30",
        "status": "A",
        "authorized_official_last_name": "GORMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-341-5565",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SD",
            "license": "0370",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "SD",
            "license": "0370",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "SD",
            "license": "0370",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "SD",
            "license": "0370",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spearfish Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Daniel Berens, DO
• Stephanie Beutler
• Morgan Bialas, MS
• Katherine M Bifulco, PT
• Krista Bree Birkelo, DO
• Black Hills Physical Therapy, Inc.
• Black Hills Psychology, LLC
• Black Hills Surgical Hospital, LLP (Black Hills Urgent Care, LLC)
• Black Hills Transit Inc
• Jessica Mae Blankenship

• Dermatology Physician in Spearfish, SD
• Providers in Spearfish, SD by specialty
• Dermatology Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; 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.