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DERMATOLOGY SPECIALISTS OF BOULDER, PC
NPI 1053449306
Dermatology - MOHS-Micrographic Surgery in Louisville, CO

Active since March 01, 2007CLIA Certified · 5 labs
1056 S 88TH ST, LOUISVILLE, CO 80027(303) 442-6647(303) 442-2696 Get Directions Write a Review

NPPES record last updated: November 14, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 14, 2024, Mar 19, 2021 (2 updates tracked since 2021).

About Dermatology Specialists Of Boulder, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY SPECIALISTS OF BOULDER, PC (NPI 1053449306) is a healthcare organization registered as a mohs-micrographic surgery in Louisville, Colorado and active in the NPI registry since March 2007. The organization holds 5 active CLIA laboratory certificates, maintains 5 additional practice locations, and lists Shawn B Allen, President, as its authorized official.

NPPES Registry Identity

NPI1053449306
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameDERMATOLOGY SPECIALISTS OF BOULDER, PC
Location Address1056 S 88TH STLouisville, CO 80027-9460
Mailing Address1056 S 88th StLouisville, CO 80027-9460 · (303) 442-6647 · Fax (303) 442-2696
Phone(303) 442-6647
Fax(303) 442-2696
Organization SubpartNo
Authorized OfficialShawn B AllenPresident · (303) 442-6647
Enumeration DateMarch 1, 2007
Last NPPES UpdateNovember 14, 20242 updates tracked since enumeration
NPPES CertifiedNovember 14, 2024
✔ NPI 1053449306 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
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.
Also ListedDermatologyTaxonomy 207N00000X · License 43816 (CO)
Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X · License 43816 (CO)
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
1056 S 88TH ST, Louisville, CO 80027
Open in Google Maps ↗

Secondary Practice Locations 5

Location 1905 W 124th Ave Ste 170Westminster, CO 80234-1716 · Phone (303) 442-6647 · Fax (303) 442-2696
Location 236 S 18th Ave Ste HBrighton, CO 80601-2452 · Phone (303) 442-6647 · Fax (303) 442-2696
Location 32880 Folsom St, Suite #200Boulder, CO 80304-3739 · Phone (303) 442-6647
Location 4776 W Eisenhower BlvdLoveland, CO 80537-3157 · Phone (303) 442-6647
Location 511990 Grant St Ste 300Northglenn, CO 80233-1135 · Phone (303) 442-6647 · Fax (303) 442-2696

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dermatology Specialists Of Boulder, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateColoradoEnrollment IDO20071004000308Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Dermatology Specialists Of Boulder, PC, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 10 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 2

Dermatology9
Micrographic Dermatologic Surgery (MDS)2

Clinicians, nearest first (11)

Christina Gamba, MD
Dermatology
NPI 1992048235
1056 S 88TH ST
Louisville, CO 80027
(303) 442-6647
✔ PECOS✔ Accepts MedicareSame address
Rachel Simmons, M.D.
Dermatology
NPI 1437393485
1056 S 88TH ST
Louisville, CO 80027
(034) 426-6473
✔ PECOS✔ Accepts MedicareSame address
Genevieve Wallace, MD
Dermatology
NPI 1750560579
1056 S 88TH ST
Louisville, CO 80027
(303) 442-6647
✔ PECOS✔ Accepts MedicareSame address
Shannon Detty, M.D.
Dermatology
NPI 1790149763
2880 FOLSOM ST STE 200
Boulder, CO 80304
(303) 442-6647
✔ PECOS✔ Accepts Medicare8.0 mi
Laura Huff, MD
Dermatology
NPI 1538458963
2880 FOLSOM ST STE 200
Boulder, CO 80304
(303) 442-6647
✔ PECOS✔ Accepts Medicare8.0 mi
Shawn Allen, MD
Micrographic Dermatologic Surgery (MDS)
NPI 1043340805
2880 FOLSOM ST STE 200
Boulder, CO 80304
(303) 442-6647
✔ PECOS✔ Accepts Medicare8.1 mi
Carol Alonso, M.D.
Dermatology
NPI 1386962256
905 W 124TH AVE STE 170
Westminster, CO 80234
(303) 442-6647
✔ PECOS✔ Accepts Medicare8.2 mi
Anastasia Benoit, M.D.
Micrographic Dermatologic Surgery (MDS)
NPI 1063708709
905 W 124TH AVE STE 170
Westminster, CO 80234
(303) 442-6647
✔ PECOS✔ Accepts Medicare8.2 mi
Arelis Burgos, MD
Dermatology
NPI 1609865427
905 W 124TH AVE STE 170
Westminster, CO 80234
(303) 442-6647
✔ PECOS✔ Accepts Medicare8.2 mi
Jessica Olander, MD
Dermatology
NPI 1659515658
905 W 124TH AVE STE 170
Westminster, CO 80234
(303) 442-6647
✔ PECOS✔ Accepts Medicare8.2 mi
Courtney Remington, MD
Dermatology
NPI 1093381170
1665 AURORA CT
Aurora, CO 80045
(720) 848-0000
✔ PECOS✔ Accepts Medicare22 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 5

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 06D1074798

Dermatology Specialists Of Boulder · Boulder, CO
Active · expires Mar 20, 2028
CLIA Number06D1074798
Laboratory TypePhysician Office
Certificate Effective DateMarch 21, 2026
Certificate Expiration DateMarch 20, 2028
Laboratory DirectorDr. Shawn B. Allen
Laboratory Phone(303) 442-6647
Laboratory LocationDermatology Specialists Of Boulder2880 Folsom St, Ste 200, Boulder, CO 80304
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 06D2124191

Dermatology Specialists · Louisville, CO
Active · expires Dec 18, 2027
CLIA Number06D2124191
Laboratory TypePhysician Office
Certificate Effective DateDecember 19, 2025
Certificate Expiration DateDecember 18, 2027
Laboratory DirectorDr. Shawn B. Allen
Laboratory Phone(303) 442-6647
Laboratory LocationDermatology Specialists1056 S 88th St, Louisville, CO 80027
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 06D0900069

Dermatology Specialists · Northglenn, CO
Active · expires Aug 10, 2027
CLIA Number06D0900069
Laboratory TypePhysician Office
Certificate Effective DateAugust 11, 2025
Certificate Expiration DateAugust 10, 2027
Laboratory DirectorDr. Shawn B. Allen
Laboratory Phone(303) 442-6647
Laboratory LocationDermatology Specialists11990 Grant Street, Suite 300, Northglenn, CO 80233
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 06D2278312

Dermatology Specialists · Loveland, CO
Active · expires Mar 14, 2027
CLIA Number06D2278312
Laboratory TypePhysician Office
Certificate Effective DateMarch 15, 2025
Certificate Expiration DateMarch 14, 2027
Laboratory DirectorDr. Shawn B. Allen
Laboratory Phone(303) 442-6647
Laboratory LocationDermatology Specialists776 W Eisenhower Blvd, Loveland, CO 80537
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 06D2113513

Dermatology Specialists · Brighton, CO
Active · expires May 23, 2028
CLIA Number06D2113513
Laboratory TypePhysician Office
Certificate Effective DateMay 24, 2026
Certificate Expiration DateMay 23, 2028
Laboratory DirectorShawn B. Allen
Laboratory Phone(303) 442-6647
Laboratory LocationDermatology Specialists36 18th Ave Ste H, Brighton, CO 80601
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatology Specialists Of Boulder, PC's NPI number?

The NPI number for Dermatology Specialists Of Boulder, PC is 1053449306. It was assigned to this organization in the NPPES registry on March 1, 2007.

Where is Dermatology Specialists Of Boulder, PC located?

Dermatology Specialists Of Boulder, PC is located at 1056 S 88th St, Louisville, CO 80027. The listed phone number is (303) 442-6647.

What is Dermatology Specialists Of Boulder, PC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Dermatology Specialists Of Boulder, PC enrolled in Medicare?

Yes. Dermatology Specialists Of Boulder, PC is registered in the Medicare PECOS enrollment system.

When is Dermatology Specialists Of Boulder, PC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Colorado, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Dermatology Specialists Of Boulder, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 2 Medicare specialties reassign their Medicare billing to Dermatology Specialists Of Boulder, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (9) and Micrographic Dermatologic Surgery (MDS) (2). Of these, 3 practice at this address and 10 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Dermatology Specialists Of Boulder, PC hold CLIA laboratory certificates?

Yes. 5 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Dermatology Specialists Of Boulder, PC was last updated on November 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.