Dermatology Associates of Southwest Washington, PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

DERMATOLOGY ASSOCIATES OF SOUTHWEST WASHINGTON, PLLC

Practice address

8614 E Mill Plain Blvd
Suite 400
Vancouver, WA 98664-2059

Phone

(360) 254-5267

Fax

(360) 254-6089

NPI assigned

Aug 25, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Joel H Datloff, M.D.NPI 1477581817

Title

Owner

Phone

(360) 254-5267

Specialties & licenses 1

Addresses

Other identifiers 1

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 6

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

• Joel H Datloff, MD

  • Dermatology Physician
  • Vancouver, WA
  • NPI 1477581817
  Medicare reassignment Care Compare group NPD Authorized official
• Laura E Brandt, PA-C

  • Physician Assistant
  • Vancouver, WA
  • NPI 1013997899
  Medicare reassignment Care Compare group
• Mary Burnell, PA-C

  • Physician Assistant
  • Vancouver, WA
  • NPI 1124416508
  Medicare reassignment Care Compare group
• Elizabeth Sims Dawson, MD

  • Dermatology Physician
  • Vancouver, WA
  • NPI 1760676910
  Medicare reassignment NPD
• Samantha Ferguson, PA-C

  • Physician Assistant
  • Olympia, WA
  • NPI 1104224047
  Medicare reassignment
• Sarah R. Blattler, LMP

  • Massage Therapist
  • Walla Walla, WA
  • NPI 1295861755
  NPD

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

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1992938906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 E MILL PLAIN BLVD",
            "address_2": "SUITE 400",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986642059",
            "telephone_number": "360-254-5267",
            "fax_number": "360-254-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8614 E MILL PLAIN BLVD",
            "address_2": "SUITE 400",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986642059",
            "telephone_number": "360-254-5267",
            "fax_number": "360-254-6089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF SOUTHWEST WASHINGTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-25",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "DATLOFF",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-254-5267",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7065758",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Depot Street Properties Inc
• Aidan H Derenne, MD
• Munib Y. Derhalli, D.M.D.
• Tania B. Derington, CRNA
• Dermatology Associates
• Matthew Derosa
• Derry Family Eyecare LLC
• Kristen Elaine Derry
• Celia Katherine Dervan, MD
• Lisa Danielle Desmarais, CNM

• Medical Specialty Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Medical Specialty Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.