The Dermatology and Skin Cancer Clinic of Alaska

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

THE DERMATOLOGY AND SKIN CANCER CLINIC OF ALASKA

Practice address

180 E Beluga Ave
Soldotna, AK 99669-8002

Phone

(907) 262-7546

Fax

(907) 262-7599

NPI assigned

Feb 28, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mathew M Cannava, M.D.NPI 1245368695

Title

President

Phone

(907) 262-7546

Specialties & licenses 7

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK

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 2

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

• Mathew M Cannava, M.D.

  • MOHS-Micrographic Surgery Physician
  • Soldotna, AK
  • NPI 1245368695

  Dermatology

  Medicare reassignment NPD Authorized official
• Kristin L Eastman, MD

  • Dermatology Physician
  • Soldotna, AK
  • NPI 1255693578
  Medicare reassignment NPD

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1831227289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 780",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996690780",
            "telephone_number": "907-262-7546",
            "fax_number": "907-262-7599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E BELUGA AVE",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996698002",
            "telephone_number": "907-262-7546",
            "fax_number": "907-262-7599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DERMATOLOGY AND SKIN CANCER CLINIC OF ALASKA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "CANNAVA",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-262-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD16711",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Swiftwater Dermatology
• Katie Tallent Maxwell, LMT
• Brittany Maurine Taylor
• Rose M Taylor
• Cindy Irene Tennessen, RN
• The Nesting Place, LLC
• Sarah Jo Theis
• Theodore Barton
• Diana Thomas
• Jeanine Susan Thomas, CARE COORDINATOR

• MOHS-Micrographic Surgery Physician in Soldotna, AK
• Providers in Soldotna, AK by specialty
• MOHS-Micrographic Surgery Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; 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.