HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC
NPI 1255449898
Dermatology - MOHS-Micrographic Surgery in Idaho Falls, ID
NPI Status: Active since August 25, 2006
Contact Information
2375 E SUNNYSIDE RD STE J
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 525-4888
Fax: (208) 525-4885
- Organization
- Dermatology
- MOHS-Micrographic Surgery
- CLIA Number: 13D0927132
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-01-2025
About HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC
This page provides the complete NPI Profile along with additional information for High Valley Dermatology & Dermatologic Surgery, Pc, a provider established in Idaho Falls, Idaho operating as a Dermatology, focusing in mohs-micrographic surgery . The healthcare provider is registered in the NPI registry with number 1255449898 assigned on August 2006. The practitioner's primary taxonomy code is 207ND0101X with license number M7012 (ID). The provider is registered as an organization and their NPI record was last updated 5 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is James R Willis M.d. (President)
- NPI
- 1255449898
- Provider Name
- HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC
- Entity Type
- Organization
- Location Address
- 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404
- Location Phone
- (208) 525-4888
- Location Fax
- (208) 525-4885
- Mailing Address
- 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404
- Mailing Phone
- (208) 525-4888
- Mailing Fax
- (208) 525-4885
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 08-25-2006
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology MOHS-Micrographic Surgery
- Taxonomy Code
- 207ND0101X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- M7012
- License State
- ID
- Taxonomy Description
- The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D0927132
- Facility Type
- Physician Office
- Certificate Effective Date
- December 02, 2023
- Certificate Expiration Date
- December 01, 2025
- Laboratory Director
- BRANDON L. MINER
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to High Valley Dermatology & Dermatologic Surgery, Pc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 5 | 5 | 4 | 4 | 9 | 8 | 9 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 10 | 5 | 8 | 4 | 18 | 8 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 1 + 0 + 5 + 8 + 4 + 1 + 8 + 8 + 1 + 8 + 24 = 72 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 72 = 8 | 8 | ||||||||
The NPI number 1255449898 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 5 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1659681534 | MANUAL SOLUTIONS PLLC Organization | Physical Therapist | 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404 (208) 206-4633 |
| 1992070809 | PAIN SPECIALISTS OF IDAHO Organization | Anesthesiology (Pain Medicine) | 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404 (208) 522-7246 |
| 1649221912 | MATTHEW R NELSON PA C Individual | Physician Assistant | 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404 (208) 522-7246 |
| 1649753740 | JARED WILLIAM RICKABAUGH APRN, FNP-C Individual | Nurse Practitioner (Family) | 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404 (208) 542-7060 |
| 1316521602 | S. ALBERTSON DERMATOLOGY AND SKIN CANCER CENTER LLC Organization | Dermatology (MOHS-Micrographic Surgery) | 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404 (208) 589-3918 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1255449898, enumerated in the NPI registry as an "organization" on August 25, 2006
The provider is located at 2375 E Sunnyside Rd Ste J Idaho Falls, Id 83404 and the phone number is (208) 525-4888
This medical organization specializes in Dermatology with taxonomy code 207ND0101X with a focus in MOHS-Micrographic Surgery
The provider's CLIA number is 13D0927132 for a "physician office" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing..
This NPI record was last updated on August 25, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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