NPIMap

Organization Active NPI

Forefront Dermatology, S.C.

  • Dermatology Physician
  • Mountain BRK, AL
National Provider Identifier
1720664907
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOREFRONT DERMATOLOGY, S.C.
Practice address
2900 Cahaba Rd
Mountain BRK, AL 35223-1937
Phone
(205) 877-9773
Fax
(205) 877-9775
NPI assigned
Mar 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Authorized official

Name
Dr. Betsy J Wernli, MD
Title
President
Phone
(920) 482-0671

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

2900 Cahaba Rd
Mountain BRK, AL 35223-1937

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Other practice location 1

150 Gilbreath Dr
Oneonta, AL 35121-2827
Phone (205) 877-9773

Other practice location 2

430 Fieldstown Rd Ste 104
Gardendale, AL 35071-2458
Phone (205) 877-9773

Other names 1

  • Village Dermatology, A Forefront Dermatology Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180911002840 AL Part B Supplier - Clinic/Group Practice 3779471701 Receives reassigned benefits from 48 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oxford, AL; Oneonta, AL; Mountain BRK, AL; Mobile, AL; Leeds, AL; Gardendale, AL; Florence, AL; Fairhope, AL…

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

250 Inverness Center Dr
Hoover, AL 35242
Phone (205) 995-5575

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1720664907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 CAHABA RD",
            "city": "MOUNTAIN BRK",
            "state": "AL",
            "postal_code": "352231937",
            "telephone_number": "205-877-9773",
            "fax_number": "205-877-9775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Gilbreath Dr",
            "address_purpose": "LOCATION",
            "city": "Oneonta",
            "state": "AL",
            "postal_code": "351212827",
            "country_code": "US",
            "telephone_number": "205-877-9773",
            "fax_number": "205-877-9775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "430 Fieldstown Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Gardendale",
            "state": "AL",
            "postal_code": "350712458",
            "country_code": "US",
            "telephone_number": "205-877-9773",
            "fax_number": "205-877-9775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-19",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "WERNLI",
        "authorized_official_first_name": "BETSY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-482-0671",
        "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
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Dermatology, A Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Village Dermatology, A Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain BRK, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.