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

Q: 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.

Q: 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.

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: November 01, 2026.

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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mat-su Dermatology, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Mat-Su Dermatology, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Robert Sorensen, M.D.

Dermatology

NPI 1073937835

2250 S WOODWORTH LOOP STE 101
Palmer, AK 99645

(907) 745-7546

✔ PECOS✔ Accepts MedicareSame address

Hal Willardson, MD

Dermatology

NPI 1275924300

2250 S WOODWORTH LOOP STE 101
Palmer, AK 99645

(907) 745-7546

✔ PECOS✔ Accepts MedicareSame address

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

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.

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.

Is Mat-Su Dermatology, LLC enrolled in Medicare?

Yes. Mat-Su Dermatology, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mat-Su Dermatology, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Mat-Su Dermatology, LLC. 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

What insurance does Mat-Su Dermatology, LLC accept?

Health plans from Moda Health Plan, Inc. and Premera Blue Cross Blue Shield of Alaska list Mat-Su Dermatology, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

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 14 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.