MAT-SU DERMATOLOGY, LLC
NPI 1063300580
Dermatology - MOHS-Micrographic Surgery in Palmer, AK
NPI Status: Active since June 24, 2025
Contact Information
2250 S WOODWORTH LOOP STE 101
PALMER, AK
ZIP 99645
Phone: (907) 745-7546
Fax: (907) 745-7540
- Organization
- Dermatology
- MOHS-Micrographic Surgery
- CLIA Number: 02D2327985
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-02-2027
About MAT-SU DERMATOLOGY, LLC
This page provides the complete NPI Profile along with additional information for Mat-su Dermatology, Llc, a provider established in Palmer, Alaska operating as a Dermatology, focusing in mohs-micrographic surgery . The healthcare provider is registered in the NPI registry with number 1063300580 assigned on June 2025. The practitioner's primary taxonomy code is 207ND0101X. The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Melody Mittelsteadt (Coo)
- NPI
- 1063300580
- Provider Name
- MAT-SU DERMATOLOGY, LLC
- Entity Type
- Organization
- Location Address
- 2250 S WOODWORTH LOOP STE 101 PALMER, AK 99645
- Location Phone
- (907) 745-7546
- Location Fax
- (907) 745-7540
- Mailing Address
- 2250 S WOODWORTH LOOP STE 101 PALMER, AK 99645
- Mailing Phone
- (907) 745-7546
- Mailing Fax
- (907) 745-7540
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-24-2025
- Last Update Date
- 08-20-2025
- 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
- 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
- 02D2327985
- Facility Type
- Physician Office
- Certificate Effective Date
- August 03, 2025
- Certificate Expiration Date
- August 02, 2027
- Laboratory Director
- DR. ROBERT H. SORENSEN
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Mat-su Dermatology, Llc 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 NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1063300580, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 50. The final step is to find the difference between that total and the next multiple of ten (50 - 50 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 50 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063300580, enumerated as an "organization" on June 24, 2025.
The provider is located at 2250 S WOODWORTH LOOP STE 101 PALMER, AK 99645 and the phone number is (907) 745-7546.
Dermatology with taxonomy code 207ND0101X and a focus in MOHS-Micrographic Surgery.
