NPIMap

Organization Active NPI

Forefront Dermatology, S.C.

  • Dermatology Physician
  • Saint Louis, MO
National Provider Identifier
1891179040
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 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
Last updated
Oct 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Authorized official

Name
Dr. Betsy J Wernli, MD
Title
President
Phone
(920) 482-0671

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

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
26D0996349Forefront Dermatology, SC816 S Kirkwood Rd Ste 210, Saint Louis, MO 63122Certificate of waiverJan 22, 2027
26D1099873Forefront Dermatology, SC5721 Osage Beach Pkwy Ste 100, Osage Beach, MO 65065Provider-performed microscopyOct 12, 2027
26D2284621Forefront Dermatology SC130 Richardson Crossing, Arnold, MO 63010ComplianceMar 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dermatology Assoc of Wi SC122 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

8567 Watson Rd
Ste A
Webster Groves, MO 63119
Phone (314) 528-9040

Practitioners & affiliated clinicians

Practitioners 38

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.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1891179040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9016",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR",
            "address_2": "SUITE 180",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-878-5599",
            "fax_number": "314-392-4290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5721 Osage Beach Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Osage Beach",
            "state": "MO",
            "postal_code": "650653030",
            "country_code": "US",
            "telephone_number": "573-302-4696",
            "fax_number": "573-302-4698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "816 S Kirkwood Rd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631226056",
            "country_code": "US",
            "telephone_number": "314-645-4500",
            "fax_number": "314-645-5907",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Richardson Xing Ste 130",
            "address_purpose": "LOCATION",
            "city": "Arnold",
            "state": "MO",
            "postal_code": "630106023",
            "country_code": "US",
            "telephone_number": "636-489-4770",
            "fax_number": "636-489-4880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "WERNLI",
        "authorized_official_first_name": "BETSY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-482-0671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; 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.