NPIMap

Organization Active NPI

Mountain West Derm - Blackhart PLLC

  • MOHS-Micrographic Surgery Physician
  • Reno, NV
National Provider Identifier
1740633015
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
193400000X Issued in NV
Legal business name
MOUNTAIN WEST DERM - BLACKHART PLLC
Practice address
640 W Moana LN
Reno, NV 89509-4903
Phone
(775) 324-0699
Fax
(775) 323-6814
NPI assigned
Jul 21, 2016
Last updated
Jul 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Authorized official

Name
Bret Blackhart, M.D.NPI 1992708655
Title
Managing Partner
Phone
(775) 882-8777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X 193400000X NV Primary

Addresses

Primary practice location

640 W Moana LN
Reno, NV 89509-4903

Mailing address

3950 GS Richards Blvd
Carson City, NV 89703-8457
Phone (775) 882-8777

Other practice location 1

9672 S McCarran Blvd
Reno, NV 89523-9205
Phone (775) 324-0699

Other practice location 2

3640 Warren Way Ste 200
Reno, NV 89509-5240
Phone (775) 324-0699

Other practice location 3

3640 Warren Way Ste 100
Reno, NV 89509-5240
Phone (775) 324-0699

Other practice location 4

3950 Gs Richards Blvd
Carson City, NV 89703-8457
Phone (775) 882-8777

Other practice location 5

5419 Reno Corporate Dr
Reno, NV 89511-2250
Phone (775) 324-0699

Other practice location 6

4814 Sparks Blvd
Sparks, NV 89436-8219
Phone (775) 324-0699

Other practice location 7

917 Tahoe Blvd Ste 101
Incline Village, NV 89451-7484
Phone (775) 324-0699

Other practice location 8

10479 Double R Blvd
Reno, NV 89521-8905
Phone (775) 850-8600

Other practice location 9

1825 Pinion Rd Ste F
Elko, NV 89801-8319
Phone (775) 299-4778

Other practice location 10

607 S Maine St
Fallon, NV 89406-3801
Phone (775) 428-1007

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161031002278 NV Part B Supplier - Clinic/Group Practice 1153609813 Receives reassigned benefits from 45 practitioners
Practice locations: Sparks, NV; Carson City, NV; Reno, NV; Incline Village, NV; Fallon, NV; Elko, NV

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

3950 Gs Richards Blvd
Carson City, NV 89703
Phone (775) 283-4080

607 S Maine St
Fallon, NV 89406
Phone (775) 428-1007

3639 Warren Way
Reno, NV 89509
Phone (775) 336-3645

3640 Warren Way
#200
Reno, NV 89509

3640 Warren Way
Ste 100
Reno, NV 89509

9672 S McCarran Blvd
Reno, NV 89523

4004 Kruse Way Pl
Ste 220
Lake Oswego, OR 97035
Phone (503) 245-2415

7801 N Lamar Blvd
Ste D81
Austin, TX 78752
Phone (512) 868-3376

1610 E Whitestone Blvd
Cedar Park, TX 78613
Phone (512) 260-3376

1125 S 2nd Ave
#A
Walla Walla, WA 99362
Phone (509) 525-9404

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1740633015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 GS RICHARDS BLVD",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897038457",
            "telephone_number": "775-882-8777",
            "fax_number": "775-888-8062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 W MOANA LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094903",
            "telephone_number": "775-324-0699",
            "fax_number": "775-323-6814"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9672 S McCarran Blvd",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895239205",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-323-6814",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3640 Warren Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895095240",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-826-4820",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3640 Warren Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895095240",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-336-3666",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3950 Gs Richards Blvd",
            "address_purpose": "LOCATION",
            "city": "Carson City",
            "state": "NV",
            "postal_code": "897038457",
            "country_code": "US",
            "telephone_number": "775-882-8777",
            "fax_number": "775-888-8062",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5419 Reno Corporate Dr",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895112250",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-323-6814",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4814 Sparks Blvd",
            "address_purpose": "LOCATION",
            "city": "Sparks",
            "state": "NV",
            "postal_code": "894368219",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-451-7501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "917 Tahoe Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Incline Village",
            "state": "NV",
            "postal_code": "894517484",
            "country_code": "US",
            "telephone_number": "775-324-0699",
            "fax_number": "775-298-7324",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10479 Double R Blvd",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895218905",
            "country_code": "US",
            "telephone_number": "775-850-8600",
            "fax_number": "775-850-8665",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1825 Pinion Rd Ste F",
            "address_purpose": "LOCATION",
            "city": "Elko",
            "state": "NV",
            "postal_code": "898018319",
            "country_code": "US",
            "telephone_number": "775-299-4778",
            "fax_number": "775-299-4690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "607 S Maine St",
            "address_purpose": "LOCATION",
            "city": "Fallon",
            "state": "NV",
            "postal_code": "894063801",
            "country_code": "US",
            "telephone_number": "775-428-1007",
            "fax_number": "775-888-8062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNTAIN WEST DERM - BLACKHART PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "BLACKHART",
        "authorized_official_first_name": "BRET",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "775-882-8777",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NV",
            "license": "193400000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; 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.