NPIMap

Organization Active NPI

Dermatology Arts, PLLC

  • Medical Specialty Clinic/Center
  • Bellevue, WA
National Provider Identifier
1790103430
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
MD60153580 Issued in WA
Legal business name
DERMATOLOGY ARTS, PLLC
Practice address
1414 116TH Ave NE Ste E
Bellevue, WA 98004-3801
Phone
(425) 753-2918
NPI assigned
Mar 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Authorized official

Name
Samir P. Master, MDNPI 1023144094
Title
Managing Member
Phone
(650) 302-2624

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X
Medical Specialty Clinic/Center 261QM2500X MD60153580 WA Primary

Addresses

Primary practice location

1414 116TH Ave NE Ste E
Bellevue, WA 98004-3801

Mailing address

PO Box 958
Mercer Island, WA 98040-0958
Phone (650) 302-2624

Other names 1

  • Dermatology Arts Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140930000860 WA Part B Supplier - Clinic/Group Practice 5597985317 Receives reassigned benefits from 10 practitioners
Practice locations: Bellevue, WA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2107490Dermatology Arts1414 116TH Ave NE Ste E, Bellevue, WA 98004ComplianceApr 4, 2028

National Provider Directory

National Provider Directory

Locations

832 102nd Ave NE
Bellevue, WA 98004
Phone (425) 753-2918

3040 78th Ave SE
Unit 958
Mercer Island, WA 98040

Practitioners & affiliated clinicians

Practitioners 11

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": "1396224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1790103430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 958",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980400958",
            "telephone_number": "650-302-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 116TH AVE NE STE E",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043801",
            "telephone_number": "425-753-2918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ARTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-31",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "MASTER",
        "authorized_official_first_name": "SAMIR",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "650-302-2624",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WA",
            "license": "MD60153580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Arts",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dermatology Arts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

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