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MAT-SU DERMATOLOGY, LLC
NPI 1063300580
Dermatology - MOHS-Micrographic Surgery in Palmer, AK

Active since June 24, 2025CLIA 02D2327985 · Certificate of Compliance
2250 S WOODWORTH LOOP STE 101, PALMER, AK 99645(907) 745-7546(907) 745-7540 Get Directions Write a Review

NPPES record last updated: August 20, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mat-su Dermatology, Llc NPPES

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

MAT-SU DERMATOLOGY, LLC (NPI 1063300580) is a healthcare organization registered as a mohs-micrographic surgery in Palmer, Alaska and active in the NPI registry since June 2025. The organization holds a CLIA Certificate of Compliance certificate valid through April 7, 2028 and lists Melody Mittelsteadt, Coo, as its authorized official.

NPPES Registry Identity

NPI1063300580
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameMAT-SU DERMATOLOGY, LLC
Location Address2250 S WOODWORTH LOOP STE 101Palmer, AK 99645-7457
Mailing Address2250 S Woodworth Loop Ste 101Palmer, AK 99645-7457 · (907) 745-7546 · Fax (907) 745-7540
Phone(907) 745-7546
Fax(907) 745-7540
Organization SubpartNo
Authorized OfficialMelody MittelsteadtCoo · (210) 897-9248
Enumeration DateJune 24, 2025
Last NPPES UpdateAugust 20, 2025
NPPES CertifiedAugust 20, 2025
✔ NPI 1063300580 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
2250 S WOODWORTH LOOP STE 101, Palmer, AK 99645
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

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 02D2327985

Mat-Su Dermatology · Palmer, AK
Active · expires Apr 7, 2028
CLIA Number02D2327985
Laboratory TypePhysician Office
Certificate Effective DateApril 8, 2026
Certificate Expiration DateApril 7, 2028
Laboratory DirectorDr. Robert H. Sorensen
Laboratory Phone(907) 745-7546
Laboratory LocationMat-Su Dermatology2250 S Woodworth Loop, Ste 101, Palmer, AK 99645
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.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERT SORENSEN M.D.
Dermatology
2250 S WOODWORTH LOOP STE 101
PALMER, AK 99645
Matanuska-Susitna Borough (907) 745-7546
DR. HAL BRET WILLARDSON MD
Dermatology
2250 S WOODWORTH LOOP STE 101
PALMER, AK 99645
Matanuska-Susitna Borough (907) 745-7546
ASHLEY NICOLE SMITH PA
Physician Assistant
2250 S WOODWORTH LOOP STE 101
PALMER, AK 99645
Matanuska-Susitna Borough (907) 745-7546

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 Mat-Su Dermatology, LLC's NPI number?

The NPI number for Mat-Su Dermatology, LLC is 1063300580. It was assigned to this organization in the NPPES registry on June 24, 2025.

Where is Mat-Su Dermatology, LLC located?

Mat-Su Dermatology, LLC is located at 2250 S Woodworth Loop Ste 101, Palmer, AK 99645. The listed phone number is (907) 745-7546.

What is Mat-Su Dermatology, LLC's specialty?

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

Does Mat-Su Dermatology, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 02D2327985) is associated with this NPI, valid through April 7, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mat-Su Dermatology, LLC was last updated on August 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.