Integrated Dermatology of Boulder Creek, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTEGRATED DERMATOLOGY OF BOULDER CREEK, LLC

Doing business as

Boulder Dermatology

Practice address

3575 Broadway St
Boulder, CO 80304-1825

Phone

(303) 449-0933

NPI assigned

Feb 29, 2016

Last updated

Jan 14, 2019By 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

Adam S Plotkin, MD

Title

Signor

Phone

(561) 314-2000

Specialties & licenses 1

Addresses

Other names 1

• Boulder Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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.

• Todd Charles Becker, M.D., PH.D.

  • MOHS-Micrographic Surgery Physician
  • Boulder, CO
  • NPI 1508049206
  Medicare reassignment Care Compare group NPD
• Allison Elise Morrison, MD

  • Dermatology Physician
  • Longmont, CO
  • NPI 1063613826
  Medicare reassignment Care Compare group NPD
• Megan Waite, M.D.

  • Dermatology Physician
  • Milwaukee, WI
  • NPI 1487946612

  CO

  Medicare reassignment Care Compare group NPD
• Rachel Quinn Collins, PA-C

  • Medical Physician Assistant
  • Greeley, CO
  • NPI 1255746095
  Medicare reassignment Care Compare group
• Berkeley Fial, PA

  • Physician Assistant
  • Boulder, CO
  • NPI 1124513981
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1790145183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-314-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3575 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803041825",
            "telephone_number": "303-449-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED DERMATOLOGY OF BOULDER CREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-29",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "PLOTKIN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SIGNOR",
        "authorized_official_telephone_number": "561-314-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boulder Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; 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.