Dermatology by Design LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD158125 Issued in OR

Legal business name

DERMATOLOGY BY DESIGN LLC

Practice address

1129 NW 11TH Ave
Portland, OR 97209-3469

Phone

(503) 705-2331

NPI assigned

Feb 21, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Omar Qutub, MDNPI 1124280540

Title

Owner

Phone

(503) 705-2331

Specialties & licenses 1

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 2

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

• Taylor Alane Dawn, PA-C

  • Dermatology Physician
  • Stanwood, WA
  • NPI 1366160087

  Dermatology, WA

  Medicare reassignment NPD
• Omar N Qutub, MD

  • Dermatology Physician
  • Portland, OR
  • NPI 1124280540

  Dermatology

  NPD Authorized official

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1972004455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 NW OVERTON ST UNIT 608",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093270",
            "telephone_number": "503-705-2331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 NW 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093469",
            "telephone_number": "503-705-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY BY DESIGN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "QUTUB",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-705-2331",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD158125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ebisa Deressa
• Paul Doug Derham, CADC-R
• Lila Derickson, ND
• George Derk, MD
• Gwendolyn Rose Derk
• Dermatology Professionals
• Craig Scott Dermer, CCC-CLP
• Tom C Deroche, M.D.
• Frances A Derook, M.D.
• Dominique Derosa, RN BSN

• All providers in Portland, OR
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.