Forefront Dermatology, S.C.
Organization Active NPI Dermatology Physician · Saint Louis, MO
NPI 1891179040 · NPPES record last updated Oct 25, 2024
Key facts
- NPI
- 1891179040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- FOREFRONT DERMATOLOGY, S.C.
- Practice address
- 12855 N 40 Dr
Suite 180
Saint Louis, MO 63141 - Phone
- (314) 878-5599
- Fax
- (314) 392-4290
- NPI assigned
- Jul 17, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Betsy J Wernli, MD
- Title
- President
- Phone
- (920) 482-0671
Other NPIs on the same Medicare enrollment 16
Corporate family (same tax ID) 11
Practitioners 38
-
Lauren Copp, PA-C
-
John D Despain, M.D.
-
Patricia L. Duggan, PA-C
-
Andrea L Garrett, M.D.
-
Shane A Grace, MD
-
Paul J Gruber, M.D.
-
Deana Lyn Kadyk, M.D.
-
Samantha R McNail, M.D.
-
Lori Renee Miller, NP-C
-
Brett Neill, MD
-
Rachel Marie Qualley, M.D.
-
Marissa Lynn Saengsamran, APRN, BC
-
Amy Schutte, M.D.
-
Emily Milford Stevenson, M.D.
-
Amy L Thayer, FNP-C
-
Audrey M Wilson, APN
-
Jennifer Renee Zabel, FNP-C
-
Jennifer Nichole Hunsaker, FNP-C
-
Autumn Lynn Bertholdi, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0996349 | Forefront Dermatology, SC | Certificate of waiver | Jan 22, 2027 |
| 26D1099873 | Forefront Dermatology, SC | Provider-performed microscopy | Oct 12, 2027 |
| 26D2284621 | Forefront Dermatology SC | Compliance | Mar 11, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150922001275 | MO | Part B Supplier - Clinic/Group Practice | 3779471701 |
Receives reassigned benefits from 38 practitioners 16 other NPIs on this enrollment Practice locations: Wildwood, MO; Wentzville, MO; Webster Groves, MO; Springfield, MO; Saint Peters, MO; Saint Louis, MO; O Fallon, MO; Monett, MO… |
National Provider Directory
- Tax ID family
- Forefront Dermatology SC
Locations
8567 Watson Rd
Ste A
Webster Groves, MO 63119
Phone (314) 528-9040
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Procedural Dermatology Physician |
207NS0135X |
Addresses
Primary practice location
12855 N 40 Dr
Suite 180
Saint Louis, MO 63141
Mailing address
801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9016
Other practice location 1
5721 Osage Beach Pkwy Ste 100
Osage Beach, MO 65065-3030
Phone (573) 302-4696
Other practice location 2
816 S Kirkwood Rd Ste 210
Saint Louis, MO 63122-6056
Phone (314) 645-4500
Other practice location 3
130 Richardson Xing Ste 130
Arnold, MO 63010-6023
Phone (636) 489-4770
Other providers in Saint Louis, MO
- Michael J Ford
- Sophia Glenda Ford
- Timothy L Ford
- Melissa R Fore
- Forefront Dermatology, S.C.
- Alyxandria Janae Foreman
- Forest Manor Health Care Center LLC
- Forest Park Anesthesia, Inc
- Forest Park Critical Care LLC
- Forest Park Emergency Physicians LLC
All providers in Saint Louis, MO · Dermatology Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.