NPIMap

Individual provider Active NPI

Bret S Blackhart, M.D.

  • Dermatology Physician
  • Reno, NV
National Provider Identifier
1992708655
Registry record updated Mar 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
7747 Issued in NV
Practice address
640 W Moana LN
Ste 2
Reno, NV 89509-4857
Phone
(775) 324-0699
Fax
(775) 888-8067
NPI assigned
May 24, 2005
Last updated
Mar 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 7747 NV Primary

Addresses

Primary practice location

640 W Moana LN
Ste 2
Reno, NV 89509-4857

Mailing address

640 W Moana LN
Reno, NV 89509-4903
Phone (775) 336-3624

Other names 1

  • Bret S. Blackhart Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110217000246 NV Practitioner - Dermatology 0547441016 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Derm California PC Dermatology CurrentSince Jun 1, 2017 Accepting new patients
Mountain West Derm-Blackhart, PLLC Dermatology CurrentSince Jul 14, 2016 Accepting new patients
Mountain West Derm - Blackhart PLLC CurrentSince Sep 2, 2016 Accepting new patients
South Lyon Health Center, Inc. Past Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
Scdi Surgery Center Past Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients
Mt Grant General Hospital Past Accepting new patients

Locations

3950 Gs Richards Blvd
Carson City, NV 89703
Phone (775) 283-4080

3640 Warren Way
Ste 100
Reno, NV 89509

640 W Moana Ln
Reno, NV 89509
Phone (775) 882-8777

640 W Moana Ln
Ste 2
Reno, NV 89509
Phone (775) 323-2135

Interoperability endpoints

  • Direct secure messaging: bblackhart@skincancerderm.emadirect.md

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551657600000",
    "number": "1992708655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 W MOANA LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094903",
            "telephone_number": "775-336-3624",
            "fax_number": "775-888-8067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 W MOANA LN",
            "address_2": "STE 2",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094857",
            "telephone_number": "775-324-0699",
            "fax_number": "775-888-8067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKHART",
        "first_name": "BRET",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2019-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NV",
            "license": "7747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRET",
            "last_name": "BLACKHART",
            "middle_name": "S.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.