MOUNTAIN WEST DERM - BLACKHART PLLC
NPI 1619517539
Clinic/Center - Ambulatory Surgical in Spokane Valley, WA
NPI Status: Active since January 08, 2020
Contact Information
1807 N HUTCHINSON RD
SPOKANE VALLEY, WA
ZIP 99212
Phone: (509) 456-7414
Fax: (509) 624-0764
- Organization
- Clinic/Center
- Ambulatory Surgical
- Accepts Insurance
- CLIA Number: 13D2032958
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 03-25-2027
About MOUNTAIN WEST DERM - BLACKHART PLLC
This page provides the complete NPI Profile along with additional information for Mountain West Derm - Blackhart Pllc, a provider established in Spokane Valley, Washington operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1619517539 assigned on January 2020. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Bret S Blackhart Md (Owner)
- NPI
- 1619517539
- Provider Name
- MOUNTAIN WEST DERM - BLACKHART PLLC
- Entity Type
- Organization
- Location Address
- 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212
- Location Phone
- (509) 456-7414
- Location Fax
- (509) 624-0764
- Mailing Address
- 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212
- Mailing Phone
- (509) 456-7414
- Mailing Fax
- (509) 624-0764
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-08-2020
- Last Update Date
- 01-08-2020
- Code Navigator
Location Map
Secondary Locations
- 1700 W Riverstone Dr
Coeur D Alene, ID 83814
(208) 770-2822
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
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Connect Bronze Expanded Standard - PPO
- Connect Bronze HDHP - PPO
- Connect Catastrophic - PPO
- Connect Gold - PPO
- Connect Gold Standard - PPO
- Connect Silver - PPO
- Connect Silver Standard - PPO
- High Plains Bronze HDHP - PPO
- High Plains Bronze Standard Expanded - PPO
- High Plains Gold - PPO
- High Plains Gold HDHP - PPO
- High Plains Gold Standard - PPO
- High Plains Silver - PPO
- High Plains Silver Standard - PPO
- Plus Bronze Expanded - PPO
- Plus Bronze Standard Expanded - PPO
- Plus Gold - PPO
- Plus Gold Standard - PPO
- Plus Silver Standard - PPO
- ACCESS BRONZE - PPO
- Premera Blue Cross Alaska One Gold - PPO
- Premera Blue Cross Preferred Bronze 5800 HSA - PPO
- Premera Blue Cross Preferred Bronze 6350 - PPO
- Premera Blue Cross Preferred Gold 1500 - PPO
- Premera Blue Cross Preferred Silver 4500 - PPO
- Premera Blue Cross Standard Bronze II - PPO
- Premera Blue Cross Standard Gold - PPO
- Premera Blue Cross Standard Silver - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Full thickness skin graft to nose, ears, eyelids, or lips, 20.0 sq cm or less
Partial thickness self skin graft to face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less
Repair of wound by transferring skin, 30.1-60.0 sq cm
Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less
Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm
Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less
Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm
Repair of wound of scalp, arms, or legs by transferring skin, 10.1-30.0 sq cm
A full thickness skin graft is a procedure where a layer of skin is taken from one area of the body and transplanted to another. If it's done on the nose, ears, eyelids, or lips, it helps restore these areas when damaged. The size of the graft is 20.0 sq cm or less.
This service was performed 109 times for 106 patientsA partial thickness self skin graft involves taking a thin layer of skin from a healthy part of your body and transplanting it to a damaged area. This procedure is used for areas such as the face, scalp, eyelids, mouth, neck, ears, hands, feet, fingers, or toes. It covers up to 100.0 sq cm or 1% body area for infants and children.
This service was performed 72 times for 70 patientsThis procedure involves repairing a wound by moving healthy skin from one area of the body to the wound site. The transferred skin, measuring between 30.1-60.0 square cm, aids in healing and reduces scarring.
This service was performed 101 times for 98 patientsThis procedure involves repairing a wound on the eyelids, nose, ears, or lips by moving a small piece of skin (10.0 sq cm or less) from one area to another. The goal is to heal the wound and restore the function and appearance of the affected area.
This service was performed 107 times for 105 patientsThis procedure involves repairing a wound on the eyelids, nose, ears, or lips by transferring skin from another part of the body. The size of the skin transferred will be between 10.1 to 30.0 square centimeters. It is performed to restore function and appearance.
This service was performed 66 times for 65 patientsThis procedure involves repairing a wound on various body parts by transferring skin from another area. The transferred skin, up to 10.0 sq cm, helps to cover the wound, promoting healing and reducing scarring. It's a common method for treating larger or deeper wounds.
This service was performed 85 times for 85 patientsThis procedure involves repairing a wound on specified body areas by transferring skin from another part of the body. The transferred skin, measuring between 10.1 to 30.0 square cm, aids in healing the wound and restoring the skin's normal function.
This service was performed 163 times for 158 patientsThis procedure involves repairing a wound on your scalp, arm, or leg by moving skin from another part of your body. The skin transferred will cover an area between 10.1 to 30.0 square cm. This helps promote healing and reduce scarring.
This service was performed 73 times for 69 patientsCLIA 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
- 13D2032958
- Facility Type
- Physician Office
- Certificate Effective Date
- March 26, 2025
- Certificate Expiration Date
- March 25, 2027
- Laboratory Director
- DR. CHAD SUKUT
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Mountain West Derm - Blackhart Pllc 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.
Reviews for MOUNTAIN WEST DERM - BLACKHART PLLC
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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 | 6 | 1 | 9 | 5 | 1 | 7 | 5 | 3 | 9 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 6 | 2 | 9 | 10 | 1 | 14 | 5 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 6 + 2 + 9 + 1 + 0 + 1 + 1 + 4 + 5 + 6 + 24 = 61 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 61 = 9 | 9 | ||||||||
The NPI number 1619517539 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 17 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1184699365 | JOEL K SEARS M.D. Individual | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1386619294 | PAUL T DUNN M.D. Individual | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1548235450 | JOSEPH L CVANCARA M.D. Individual | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1215023007 | ANDREA MEAD DOMINEY M.D. Individual | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1154408631 | MS. ELIZABETH JOAN JACOBSEN PA-C Individual | Physician Assistant (Medical) | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1467673061 | CHADD SUKUT MD Individual | Dermatology (MOHS-Micrographic Surgery) | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1710213558 | KATHLEEN R LEJAMEYER ARNP Individual | Nurse Practitioner | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1477853760 | THOMAS M RYAN, MD, Organization | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1689636649 | JEANNE M ELLERN PAC Individual | Physician Assistant (Medical) | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1881660751 | ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC Organization | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1710952882 | ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC Organization | Clinic/Center (Ambulatory Surgical) | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1972579845 | ADVANCED DERMATOLOGY AND SKIN SURGERY PLLC Organization | Clinical Medical Laboratory | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1194790006 | STACI M HESTDALEN M.D. Individual | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1013557933 | MOUNTAIN WEST DERM - BLACKHART PLLC Organization | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1437230786 | DR. ROBIN LOUISE HORNUNG MD Individual | Dermatology | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1841931425 | MAGGIE ROSE CALLAN PA-C Individual | Physician Assistant | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
| 1164692950 | ERIN MONICA NULF PA-C Individual | Physician Assistant | 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 (509) 456-7414 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1619517539, enumerated in the NPI registry as an "organization" on January 08, 2020
The provider is located at 1807 N Hutchinson Rd Spokane Valley, Wa 99212 and the phone number is (509) 456-7414
This medical organization specializes in Clinic/Center with taxonomy code 261QA1903X with a focus in Ambulatory Surgical
The provider might be accepting Accepts: Mountain Health CO-OP and Premera Blue Cross Blue. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The most common procedures or services performed by this practitioner are: Full thickness skin graft to nose, ears, eyelids, or lips, 20.0 sq cm or less, Partial thickness self skin graft to face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less, Repair of wound by transferring skin, 30.1-60.0 sq cm, Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less, Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm, Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less, Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm and Repair of wound of scalp, arms, or legs by transferring skin, 10.1-30.0 sq cm.
The provider's CLIA number is 13D2032958 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 January 08, 2020. 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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