Modern Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

60048520 Issued in WA

Legal business name

MODERN DERMATOLOGY, PLLC

Practice address

1021 Mercer St
Seattle, WA 98109

Phone

(206) 486-2982

Fax

(206) 973-5380

NPI assigned

Mar 11, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Heather D Rogers, MDNPI 1376717363

Title

Owner

Phone

(206) 486-2982

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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 6

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

• Heather D Rogers, MD

  • Dermatology Physician
  • Seattle, WA
  • NPI 1376717363
  Medicare reassignment Care Compare group NPD Authorized official
• James Connelley Collyer, M.D.

  • Dermatology Physician
  • Seattle, WA
  • NPI 1396907960
  Medicare reassignment Care Compare group NPD
• Richard B Grabowski, MD

  • Dermatology Physician
  • Seattle, WA
  • NPI 1194720680
  Medicare reassignment Care Compare group NPD
• Robin A Green Whipple, MD

  • Dermatology Physician
  • Seattle, WA
  • NPI 1730185083
  Medicare reassignment Care Compare group NPD
• Joan Leavens, MD

  • Dermatology Physician
  • Seattle, WA
  • NPI 1518321074
  Medicare reassignment Care Compare group NPD
• Carly Roman, MD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1629416433

  WA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1790178010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 MERCER ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98109",
            "telephone_number": "205-489-3206",
            "fax_number": "206-973-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 MERCER ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98109",
            "telephone_number": "206-486-2982",
            "fax_number": "206-973-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-11",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-486-2982",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "WA",
            "license": "60048520",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Marie Mariko Mock, PHARM.D.
• Charles N Mock, MD
• Timothy Glenn Mock, O.D.
• Blair Kristen Mockler, MD
• Amir Modarressi, MD
• Purvi Mody
• Michael David Modzelewski, MD
• Ashlee Kay Moe, BT
• Jennifer Diane Moe, M.D.
• Kristen Sean Moe

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.