Yakima Valley Dermatology Inc. , PS

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

YAKIMA VALLEY DERMATOLOGY INC. , PS

Doing business as

Valley Dermatology Associates
Valley Dermatology Associates P.S., INC

Practice address

3911 Castlevale Rd Ste 301
Yakima, WA 98902-7807

Phone

(509) 966-7899

Fax

(509) 225-6811

NPI assigned

Sep 24, 2007

Organization subpart

No

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

Authorized official

Name

Heather Braswell

Title

Clinical Manager

Phone

(509) 966-7899

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 2

• Valley Dermatology Associates Doing business as
• Valley Dermatology Associates P.S., INC Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 10

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

• Kirk Torgle Ecklund, MD

  • MOHS-Micrographic Surgery Physician
  • Yakima, WA
  • NPI 1154432904

  Dermatology

  Medicare reassignment Care Compare group NPD
• Benjamin Blaine Jones, M.D.

  • Dermatology Physician
  • Yakima, WA
  • NPI 1508250432
  Medicare reassignment Care Compare group NPD
• Jocelyn A Judd, PA

  • Physician Assistant
  • Ellensburg, WA
  • NPI 1952730608
  Medicare reassignment Care Compare group NPD
• Molly Rose McCusker, NP

  • Nurse Practitioner
  • Yakima, WA
  • NPI 1750118535
  Medicare reassignment Care Compare group NPD
• Zachary Tilton Stevens

  • Physician Assistant
  • Seattle, WA
  • NPI 1205316056
  Medicare reassignment Care Compare group NPD (past)
• Dominic Dephillips

  • Physician Assistant
  • Chelan, WA
  • NPI 1780353813
  Medicare reassignment Care Compare group
• Jennifer Williams

  • Physician Assistant
  • Yakima, WA
  • NPI 1003007279
  Medicare reassignment Care Compare group
• Melissa K Nicholas, PA-C

  • Medical Physician Assistant
  • Houston, TX
  • NPI 1215197694

  WA

  Medicare reassignment Care Compare group
• Jason L Berreman, ARNP C

  • Nurse Practitioner
  • Yakima, WA
  • NPI 1225149073
  NPD (past)
• Idolina Maltos, PA

  • Family Medicine Physician
  • Yakima, WA
  • NPI 1891708574
  NPD (past)

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1710173703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3911 CASTLEVALE RD STE 301",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989027807",
            "telephone_number": "509-966-7899",
            "fax_number": "509-225-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3911 CASTLEVALE RD STE 301",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989027807",
            "telephone_number": "509-966-7899",
            "fax_number": "509-225-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YAKIMA VALLEY DERMATOLOGY INC. , PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "BRASWELL",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CLINICAL MANAGER",
        "authorized_official_telephone_number": "509-966-7899"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004546",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8178956",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Dermatology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Dermatology Associates P.S., INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Dermatology Associates P.S., INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Yakima Valley Farm Workers Clinic

• Dermatology Physician in Yakima, WA
• Providers in Yakima, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.