Active NPI
Billings Dermatology PC
- Dermatology Physician
- Worland, WY
National Provider Identifier
1902400690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- BILLINGS DERMATOLOGY PC
- Practice address
- 1106 Big Horn Ave
Worland, WY 82401-2803 - Phone
- (406) 294-9515
- NPI assigned
- Nov 24, 2020
- Last updated
- Nov 24, 2020
- Organization subpart
- Yes
- Parent organization
- BILLINGS DERMATOLOGY PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michelle Qualls
- Title
- Practice Manager
- Phone
- (406) 294-9515
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary | ||
| MOHS-Micrographic Surgery Physician | 207ND0101X |
Addresses
Primary practice location
1106 Big Horn Ave
Worland, WY 82401-2803
Mailing address
1106 Big Horn Ave
Worland, WY 82401-2803
Phone (406) 294-9515
Other names 1
- Billings Dermatology PC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210505003210 | WY | Part B Supplier - Clinic/Group Practice | 1951718170 |
Receives reassigned benefits from 3 practitioners Practice locations: Worland, WY |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Billings Dermatology PC
Practitioners & affiliated clinicians
Practitioners 3
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606176000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1606176000000",
"number": "1902400690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1106 BIG HORN AVE",
"city": "WORLAND",
"state": "WY",
"postal_code": "824012803",
"telephone_number": "406-294-9515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1106 BIG HORN AVE",
"city": "WORLAND",
"state": "WY",
"postal_code": "824012803",
"telephone_number": "406-294-9515"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BILLINGS DERMATOLOGY PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BILLINGS DERMATOLOGY PC",
"enumeration_date": "2020-11-24",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A",
"authorized_official_last_name": "QUALLS",
"authorized_official_first_name": "MICHELLE",
"authorized_official_title_or_position": "PRACTICE MANAGER",
"authorized_official_telephone_number": "406-294-9515"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Billings Dermatology PC",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Worland, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.