NPIMap

Organization Active NPI

Lark Dermatology

  • Dermatology Physician
  • Bonney Lake, WA
National Provider Identifier
1982256970
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LARK DERMATOLOGY
Practice address
21137 State Route 410 E Ste I
Bonney Lake, WA 98391-8775
Phone
(253) 862-5275
NPI assigned
Jul 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
Daniel Levy, MDNPI 1306067814
Title
Medical Director
Phone
(253) 862-5257

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

21137 State Route 410 E Ste I
Bonney Lake, WA 98391-8775

Mailing address

21137 State Route 410 E Ste I
Bonney Lake, WA 98391-8775
Phone (253) 862-5275

Other identifiers 1

IdentifierTypeStateIssuer
NAOtherNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200117000568 WA Part B Supplier - Clinic/Group Practice 8820423981 Receives reassigned benefits from 6 practitioners
Practice locations: Bellingham, WA; Bonney Lake, WA

National Provider Directory

National Provider Directory

Locations

2075 Barkley Blvd
Ste 220
Bellingham, WA 98226
Phone (360) 647-0220

21137 Sr 410 E
Ste 1
Bonney Lake, WA 98391

21137 State Route 410 E
Ste I
Bonney Lake, WA 98391
Phone (253) 862-5275

18209 Sr 410 E
Ste 200
Bonney Lake, WA 98391

4323 SW Admiral Way
Seattle, WA 98116

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1982256970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21137 STATE ROUTE 410 E STE I",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918775",
            "telephone_number": "253-862-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21137 STATE ROUTE 410 E STE I",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918775",
            "telephone_number": "253-862-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARK DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-10",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "LEVY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "253-862-5257",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NA",
            "identifier": "NA",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

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

Verify at the official NPI Registry.